Time for Oncologists to Opt-In for Routine Opt-Out HIV testing?

Human immunodeficiency virus (HIV) infected individuals are at high risk for malignancies. However, it is not currently standard of care to test routinely all cancer patients for HIV. In 2006, the Centers for Disease Control (CDC) recommended HIV testing in all healthcare settings, calling for standard non-targeted “opt-out ” HIV screening. For a variety of reasons, routine opt-out HIV testing is still not widely utilized in the United States. Although many barriers to routine opt-out HIV testing have been addressed, such opt-out HIV testing continues to be conducted primarily in venues which target specific patient populations such as pregnant women. Although opt-out testing has been piloted in emergency departments, less emphasis has been placed on opt-out HIV testing in other clinical settings. We describe the background, rationale, and evidence for supporting opt-out HIV testing as routine care for cancer patients, and discuss evidence for its potential to improve clinical outcomes by facilitating appropriate HIV management during cancer treatment for those individuals who are found to be HIV positive