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The Deadliest Catch: Fishing for HIV in New Waters

Christopher D. Pilcher, MD; and C. Bradley Hare, MD
[+] Article, Author, and Disclosure Information

From San Francisco General Hospital, San Francisco, CA 94110.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Christopher D. Pilcher, MD, HIV/AIDS Division, San Francisco General Hospital, 995 Potrero Avenue, Ward 84, Building 80, San Francisco, CA 94110; e-mail, cpilcher@php.ucsf.edu.

Current Author Addresses: Drs. Pilcher and Hare: HIV/AIDS Division, San Francisco General Hospital, 995 Potrero Avenue, Ward 84, Building 80, San Francisco, CA 94110.

Ann Intern Med. 2008;149(3):204-205. doi:10.7326/0003-4819-149-3-200808050-00011
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In the absence of an effective HIV vaccine, case findings and treatments are the mainstay of HIV prevention. Effective treatments are available, but more than 25% of HIV-infected individuals in the United States may not know that they are infected (1). Perhaps as a result, the rate of HIV transmission in the United States seems to be holding steady (23). Two years ago, the Centers for Disease Control and Prevention (CDC) responded by announcing a bold new strategy to curb HIV transmission: screening average-risk individuals in an attempt to bring more people with HIV infection into treatment and care. The new strategy proposed reaching beyond HIV voluntary counseling and testing sites (places where people who believe they are at risk for HIV can get tested) to screen for HIV in other medical settings. Additional key recommendations included simplifying requirements for obtaining written informed consent for HIV testing and increasing the use of rapid HIV tests, which would make it possible to test and deliver a preliminary positive result during a single brief visit. The vision guiding these policy recommendations was to make HIV screening a routine procedure in U.S. primary care clinics, urgent care centers, emergency departments, and hospital wards (2).


hiv ; hiv screen

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HIV assays and the hazards of Bayesian probability
Posted on August 11, 2008
Tom Goffman
Director, CINR
Conflict of Interest: None Declared

TO THE EDITOR: HIV testing in populations with a low incidence raises the specter of Bayes' Theorem. Part of Bayesian probability theory aptly shows that when the incidence of a disease is infrequent in the population tested, more false positives are likely. This statistical problem may affect testing for HIV in emergency rooms where the new "˜rapid tests' showed considerable false positive results (1) 1. Pilcher CD, Hare CB The Deadliest Catch: Fishing for HIV in New Waters. Ann Intern Med, 2008:149:202-5.

Conflict of Interest:

The author, at arms length, accepts industry monies for food for resident conferences.

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