Rochelle P. Walensky, MD, MPH; Christian Arbelaez, MD, MPH; William M. Reichmann, MA; Ron M. Walls, MD; Jeffrey N. Katz, MD, MSc; Brian L. Block, BA; Matthew Dooley, BA; Adam Hetland, BA; Simeon Kimmel, BA; Jessica D. Solomon, BS; Elena Losina, PhD
Acknowledgment: The authors thank the co-investigators and staff of the USHER Trial, including Carrie Braverman, Susan Larrabee, Regina Mikulinsky, Paul Sax, and Elizabeth Wright. They also thank the faculty and staff of Brigham and Women's Hospital emergency department for their participation in the USHER Trial and for their dedication to the identification of undiagnosed HIV infection, especially the emergency service assistants and focus group members. Finally, they thank Kenneth A. Freedberg, MD, MSc, and A. David Paltiel, PhD, for critical review of the manuscript; Doug Owens, MD, for advice and study critique; and Mariam Fofana for technical assistance.
Grant Support: By the National Institute of Mental Health (R01 MH073445, R01 MH65869) and the Doris Duke Charitable Foundation, Clinical Scientist Development Award (Dr. Walensky).
Potential Financial Conflicts of Interest: None disclosed.
Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Walensky (e-mail, email@example.com).
Requests for Single Reprints: Rochelle P. Walensky, MD, MPH, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Walensky: Division of General Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.
Drs. Arbelaez and Walls: Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Mr. Reichmann and Drs. Katz and Losina: Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis Street, BC 4-4016, Boston, MA 02115.
Mr. Block: Partners AIDS Research Center, 149 13th Street, Room 5234k, Charlestown, MA 02129.
Mr. Dooley, Mr. Hetland, Mr. Kimmel, and Ms. Solomon: Department of Emergency Medicine, USHER Trial Research Assistant, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Author Contributions: Conception and design: R.P. Walensky, E. Losina.
Analysis and interpretation of the data: R.P. Walensky, W.M. Reichmann, J.N. Katz.
Drafting of the article: R.P. Walensky, C. Arbelaez, E. Losina.
Critical revision of the article for important intellectual content: R.P. Walensky, C. Arbelaez, W.M. Reichmann, R.M. Walls, J.N. Katz, B.L. Block, M. Dooley, A. Hetland, S. Kimmel, J.D. Solomon, E. Losina.
Final approval of the article: R.P. Walensky, C. Arbelaez, W.M. Reichmann, J.N. Katz, B.L. Block, M. Dooley, A. Hetland, S. Kimmel, J.D. Solomon, E. Losina.
Provision of study materials or patients: R.P. Walensky, R.M. Walls.
Statistical expertise: W.M. Reichmann, J.N. Katz, E. Losina.
Obtaining of funding: R.P. Walensky.
Administrative, technical, or logistic support: R.M. Walls, B.L. Block, M. Dooley, A. Hetland, S. Kimmel, J.D. Solomon.
Collection and assembly of data: R.P. Walensky, W.M. Reichmann, B.L. Block, M. Dooley, A. Hetland, S. Kimmel, J.D. Solomon.
ClinicalTrials.gov registration number: NCT00502944.
Walensky R., Arbelaez C., Reichmann W., Walls R., Katz J., Block B., Dooley M., Hetland A., Kimmel S., Solomon J., Losina E.; Revising Expectations from Rapid HIV Tests in the Emergency Department. Ann Intern Med. 2008;149:153-160. doi: 10.7326/0003-4819-149-3-200808050-00003
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Published: Ann Intern Med. 2008;149(3):153-160.
In 2006, the Centers for Disease Control and Prevention (CDC) revised guidelines for HIV screening to recommend that all adults and adolescents (age 13 to 64 years) be offered an HIV screening test in health care settings, including emergency departments (1). The availability of rapid HIV tests has facilitated the implementation of such universal screening practices (2–4). Screening guidelines have become more aggressive because, in the era of potent antiretroviral therapy, timely diagnosis of HIV infection is critical to ensure maximal treatment benefits. Favorable treatment outcomes have transformed HIV infection from a fatal condition to a chronic disease with a life expectancy that exceeds 20 years from treatment initiation (5). During the past 3 years, the approval of rapid HIV tests, the newly recommended HIV screening policy, and advances in HIV management have motivated the transition from targeted HIV testing to universal HIV screening.
james r korb
Southern California Permanente Medical Group
August 21, 2008
Post-test probability only 16% for rapid HIV test
In the abstract, Wallensky et.al reported that the rapid HIV test, when used in the emergency room had specificity of 96.9%. The chance that a person with a positive rapid test actually had HIV was 16% (5/31). It would be more helpful to cite this post-test probability of 16% in the abstract rather than the specificity of the test. Conflict of Interest:
Hadi Meeran Hussain
Department Of Internal Medicine,combined military hospital,lahore
August 26, 2008
Revising expectations from rapid HIV tests in the emergency department.
In this study by Walensky et al,the authors report on the experience of implementing a rapid oral HIV screening test in 849 unselected patients in Massachusetts.(1) Before we start promoting rapid, non-invasive HIV screening in the emergency department and perhaps in other health care settings, we must have evidence that the proposed screening method is fully reliable. Thirty-nine patients had a reactive result, but of the 31 patients who allowed a confirmatory serum testing, only five (16%) were HIV-infected. The specificity of the rapid oral test was lower than anticipated. Although the study clearly shows that the specificity of the oral test utilized is low in this setting, the sensitivity was not assessed because the non-reactive test results were not confirmed.
1.Walensky RP, Arbelaez C, Reichmann WM, Walls RM, Katz JN, Block BL, Dooley M, Hetland A, Kimmel S, Solomon JD, Losina E.Revising expectations from rapid HIV tests in the emergency department.Ann Intern Med 2008;149(3):153-60
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Emergency Medicine, Infectious Disease, HIV, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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