An HIV test should be almost as common as a cholesterol check, say U.S. federal health officials, who recommended routine testing for the AIDS virus for most Americans.

The U.S. Centers for Disease Control and Prevention in Atlanta said people between the ages of 13 and 64 should be tested for the virus when they get other routine medical tests, although not every year unless they are at risk for AIDS.

The guidelines could help end the stigma of HIV testing, prevent further spread of the disease, and lead to needed care for an estimated 250,000 Americans who don't yet know they have it, CDC officials said Thursday.

Nearly half of new HIV infections are discovered when doctors are trying to diagnose a patient who has already grown sick with an HIV-related illness, CDC officials said.

"By identifying people earlier through a screening program, we'll allow them to access life-extending therapy, and also through prevention services, learn how to avoid transmitting HIV infection to others," said Dr. Timothy Mastro, acting director of the CDC's division of HIV-AIDS prevention.

In Canada, the Public Health Agency of Canada is working with provincial and territorial governments to develop a framework that will help them make decisions on HIV testing policies, said spokesman Alain Desroches.

"The framework will address a range of issues such as ways to increase the proportion of people who are aware of their HIV status, testing during pregnancy, testing of marginalized groups, and ethical and human rights considerations," he said in a statement.

An estimated 57,000 Canadians are living with HIV, and about 27 per cent of them are unaware they are infected, he said.

Although some groups raised concerns, the announcement in the United States was mostly embraced by health policy experts, doctors and patient advocates, including the American Medical Association, which urged doctors to comply.

Expanded testing 

The recommendations aren't legally binding, but they influence what doctors do and what health insurance programs cover.

Some doctors groups predict the recommendations will be challenging to implement, requiring more money and time for testing, counselling and revising consent procedures.

Physicians also question whether there is enough evidence to expand testing beyond high-risk groups, said Dr. Larry Fields, president of the American Academy of Family Physicians.

Previously, the CDC recommended routine testing for those at high-risk for catching the virus, such as intravenous drug users and gay men, and for hospitals and certain other institutions serving areas where HIV is common. It also recommended testing for all pregnant women.  

Consent challenges

Under the new guidelines, patients would be tested for HIV as part of the standard tests they get when they go for urgent or emergency care, or even during a routine physical.

The CDC recommends everyone get tested at least once, but annual testing is urged only for people at high risk.

Consent for the test would be covered in a clinic or hospital's standard care consent form. Patients would be allowed to decline the testing. The CDC's guidelines say no one should be tested without their knowledge.

An American Civil Liberties Union official protested the CDC's idea of dealing with HIV on standard consent forms, and the agency's de-emphasis of pre-test counselling.