An assessment of rapid HIV testing offered in emergency room settings found the OraQuick ADVANCE Rapid HIV-1/2 Antibody Test produced a high rate of false-positives.
Between February and October 2007, 849 adults who visited the emergency department at Boston's Brigham and Women's Hospital consented to rapid HIV testing, reported Dr. Rochelle P. Walensky and co-authors. Of 39 patients with reactive results, 31 agreed to confirmatory testing and just five proved to be HIV-infected. Among these initially positive patients, 13 of the 26 shown to be HIV-negative had indeterminate Western blot results, and one had an initial HIV RNA level in the detectable range. All 26 uninfected patients had a non-reactive serum enzyme-linked immunoassay.
According to the researchers, "the estimated prevalence of newly identified HIV infection was 0.6 percent, which supports continued screening in the emergency department in compliance with the CDC guidelines."
As a result of false-positive rates considerably higher than suggested by test's manufacturer, the authors recommend the "addition of HIV RNA testing to the confirmation algorithm for rapid HIV screening tests in the United States." Further, "it is critical that health care providers be appropriately trained to assist patients in interpreting test results and facilitate appropriate follow-up," they said.
"Patients go to acute care settings when they develop symptoms of acute HIV infection," said Drs. Christopher D. Pilcher and C. Bradley Hare in a related editorial. "Acute HIV infection is the most infectious stage of HIV disease and is, consequently, a public health emergency in which sexual and injection partners can be protected from high risk for infection if HIV is promptly diagnosed and patients are counseled," the San Francisco General Hospital physicians said.
Because false-positive results will occur, "acute care settings must have standardized confirmatory testing and quality assurance monitoring programs," Pilcher and Hare stressed.
The study, "Revising Expectations from Rapid HIV Tests in the Emergency Department," and the editorial, "The Deadliest Catch: Fishing for HIV in New Waters," were published in the Annals of Internal Medicine (2008;149(3):153-160 and 204-205, respectively).
08/19/08
UNITED STATES: Rapid HIV Test Has High False-Positive Rate
Source: Reuters(08.05.08); Courtesy of the CDC National Center for HIV, STD, and TB Prevention