Joel E. Gallant, MD, MPH

Jake” was a 17-year-old high school student who came to see me with his supportive but anxious mother. Four months earlier, Jake’s pediatrician, having read the CDC recommendations for routine testing of all patients aged 13 to 64,

In contrast to previous conferences, at this year’s Conference on Retroviruses and Opportunistic Infections (CROI), held February 8 through 11 in Montreal, there were few presentations on major clinical trials of antiretroviral therapy and little news on investigational agents was reported. Nevertheless, there were a number of important studies dealing with the treatment of HIV infection, a few of which I’ll summarize here.

For the first 25 years of the AIDS epidemic, HIV testing was treated differently from all other types of medical diagnostic testing. Formal pretest and posttest counseling was required, and patients had to give written informed consent before being tested. The need for testing was focused primarily on assessment of risk, which required the taking of a detailed sexual and drug use history for which few clinicians had the time, training, or inclination. The rationale for this particular form of “HIV exceptionalism” was mostly historical, dating back to times when concerns about stigma; discrimination; and loss of insurance, jobs, or housing outweighed any modest benefit that might have been derived from early medical care.