| HIV continues to be a major global health problem with approximately 2.5 million new cases occurring each year. Research in the area of HIV/AIDS has demonstrated that genotype can affect the likelihood of HIV infection with exposure to the virus, disease progression, and the effectiveness of immune defenses. Specifically, the genetic polymorphisms CCR5-432 and CCR2-64I may alter HIV-1 susceptibility and/or progression from HIV-1 to AIDS by affecting the production of chemokine receptors in the body. Genetic testing for these HIV-1 protective alleles has clinical relevance, as positive test results can have an impact on the medical management of HIV-1 infected individuals. Although genetic testing has no clinical relevance for uninfected individuals, it may be information they wish to access. As of now, genetic testing for HIV-1 protective alleles is only offered direct-to-consumer (DTC). Because it may create disincentives for compliance with medical regimens or safe sex behavior, genetic testing for HIV protective alleles has potentially negative implications for both personal and public health. The majority of genetic counselors who participated in a survey on the subject of genetic testing for HIV-1 protective alleles were in favor of requiring educational efforts on the part of clinicians and public health professionals to address this risk. For similar reasons, the majority of respondents indicated that DTC genetic testing for protective HIV alleles is acceptable only when counseling is either provided or a mandatory part of the process. However, there was broad agreement that it is an individual's right to pursue genetic testing for CCR5-Delta32 and CCR2-64I, regardless of the implications for personal and public health. Mandatory counseling by genetic counselors can help provide access to information while helping to prevent the potential for personal and public health harm created by DTC genetic testing for HIV-1 protective alleles. |
