A. David Paltiel, PhD; Rochelle P. Walensky, MD, MPH; Kenneth A. Freedberg, MD, MSc
Potential Financial Conflicts of Interest: None disclosed.
Paltiel A., Walensky R., Freedberg K.; Impact of Expanded HIV Screening. Ann Intern Med. 2007;147:146-147. doi: 10.7326/0003-4819-147-2-200707170-00019
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Published: Ann Intern Med. 2007;147(2):146-147.
We share Dr. Lander's concern regarding false-positive results with rapid HIV tests, especially in populations with low HIV prevalence, and we agree that guidelines for communicating findings to patients will be useful. However, we believe that his presentation of the issue is overstated. First, we deliberately accentuated the false-positive problem by adopting a conservative specificity assumption (97.5%). Today's rapid HIV tests have higher reported specificities (99.3% to 99.6%) and, therefore, have more favorable predictive values (1). Second, current approaches to screening for other chronic diseases (mammography for breast cancer, for example) suggest that diagnostic tests with high false-positive rates can be appropriately managed in the clinical setting (2). Practitioners can explain that whereas a negative result is a reliable indicator of the absence of HIV infection (setting aside the 3-month pre-seroconversion “window” period), an initial positive result is not conclusive for HIV but highlights the need for more specific tests.
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