Christopher D. Pilcher, MD; David Alain Wohl, MD; Charles B. Hicks, MD
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Pilcher CD, Wohl DA, Hicks CB. Diagnosing Primary HIV Infection. Ann Intern Med. 2002;136:488. doi: 10.7326/0003-4819-136-6-200203190-00016
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Published: Ann Intern Med. 2002;136(6):488.
TO THE EDITOR:
Daar and colleagues' (1) primary conclusion—that symptoms do not allow focused screening for primary HIV infection—may not be justified since “compatible symptoms” in part determined inclusion in their study and performance of their gold standard test. Furthermore, the statement that clinicians may be confident that “more than 90%” of patients with primary HIV infection will be identified by a standard HIV p24 antigen test alone is potentially misleading for several reasons. First, the study's sensitivity estimate of 88.7% for the p24 antigen test is relatively imprecise, with a 95% CI whose lower boundary was 77%. Second, the sensitivity of the p24 antigen assay depends on the time between onset of symptoms of primary HIV infection and screening, since antigenemia disappears during primary HIV infection (2). Significant delay before diagnosis of primary HIV infection may be typical in areas other than those served by well-connected clinics in urban centers.
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