Eliezer M. Van Allen, MD; R. Jeffrey Kohlwes, MD, MPH
Potential Financial Conflicts of Interest: None disclosed.
Van Allen EM, Kohlwes RJ. Comments on the Recent Clinical Guidance Statement on HIV Screening. Ann Intern Med. 2009;151:286. doi: 10.7326/0003-4819-151-4-200908180-00015
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Published: Ann Intern Med. 2009;151(4):286.
TO THE EDITOR:
Although we agree in principle with the guidelines set forth by Qaseem and colleagues (1) regarding HIV screening and have generally adopted similar practices in our clinics, we are concerned that some consequences of universal screening were not addressed in this article. Specifically, assuming the sensitivity and specificity to be greater than 99% and greater than 99.99%, respectively, for the sequential screening test (initial enzyme immunoassay followed by either confirmatory Western blot or immunofluorescent assay) and the U.S. population estimate for number of persons older than 13 years to be 244 926 386 persons (2), then applying sequential universal screening to this population would result in 24 393 false-positive HIV test results. This is an unfortunate consequence of universal screening, and no mention is made of the cost of misdiagnosis, which could involve unnecessary medical intervention and squandering of limited health care resources (3).
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