Inaam A. Nakchbandi, MD; J. Craig Longenecker, MD, MPH; David Gary Smith, MD
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Nakchbandi I., Longenecker J., Smith D.; HIV Testing in Pregnant Women. Ann Intern Med. 1998;129:1075. doi: 10.7326/0003-4819-129-12-199812150-00020
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Published: Ann Intern Med. 1998;129(12):1075.
Dr. Wong suggests that we did not model the impact of false-positive HIV test results in our analysis. He also suggests that the principle of patient autonomy effectively argues against the implementation of any mandatory screening program.
Testing for HIV is a two-step process, so that one must apply the operating characteristics sequentially. The combined specificity is on the order of 0.9999926 [1, 2]. Thus, the number of possible false-positive results out of 1.6 million screened women is approximately 11, not 16 000 as suggested by Dr. Wong. Second, and probably more important, any patient with positive results on Western blot should have HIV RNA levels measured to determine the viral burden or to confirm HIV infection in someone with a suspected false-positive result. The HIV RNA or other available tests would probably identify any false-positive results. Therefore, the theoretical problem of a false-positive result should not affect our analysis.
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