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Revising expectations from rapid HIV tests in the emergency department.
- Source :
-
Annals of internal medicine [Ann Intern Med] 2008 Aug 05; Vol. 149 (3), pp. 153-60. - Publication Year :
- 2008
-
Abstract
- Background: Expanded HIV screening efforts in the United States have increased the use of rapid HIV tests in emergency departments. The reported sensitivity and specificity of rapid HIV tests exceed 99%.<br />Objective: To assess whether a reactive rapid oral HIV test result correctly identifies adults with HIV infection in the emergency department.<br />Design: Diagnostic test performance assessment within the framework of a randomized, clinical trial.<br />Setting: Brigham and Women's Hospital emergency department (Boston, Massachusetts) from 7 February to 1 October 2007.<br />Patients: 849 adults with valid rapid oral HIV test results.<br />Intervention: Rapid HIV testing with the OraQuick ADVANCE Rapid HIV-1/2 Antibody Test (OraSure Technologies, Bethlehem, Pennsylvania). Patients with reactive rapid test results were offered enzyme-linked immunoassay, Western blot, and plasma HIV-1 RNA testing for confirmation.<br />Measurements: Specificity and positive likelihood ratio.<br />Results: 39 patients had reactive results (4.6% [95% CI, 3.2% to 6.0%]). On confirmation, 5 patients were HIV-infected (prevalence, 0.6% [CI, 0.1% to 1.1%]) and 26 were non-HIV-infected (8 patients declined confirmation). The estimated rapid test specificity was 96.9% (CI, 95.7% to 98.1%). Sensitivity analyses of the true HIV status of unconfirmed cases and test sensitivity resulted in a positive likelihood ratio of 8 to 32. Western blot alone as a confirmation test provided conclusive HIV status in only 50.0% (CI, 30.8% to 69.2%) of patients at first follow-up. The addition of HIV-1 RNA testing to the confirmation protocol improved this rate to 96.2% (CI, 88.8% to 100.0%).<br />Limitation: Test sensitivity cannot be assessed because nonreactive OraQuick test results were not confirmed.<br />Conclusion: Although patients with a reactive oral OraQuick HIV screening test in the emergency department had an 8- to 32-fold increased odds of HIV infection compared with the pretest odds, the specificity of the test was lower than anticipated.
Details
- Language :
- English
- ISSN :
- 1539-3704
- Volume :
- 149
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Annals of internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 18678842
- Full Text :
- https://doi.org/10.7326/0003-4819-149-3-200808050-00003