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1. Revising expectations from rapid HIV tests in the emergency department.

   • Hadi Meeran Hussain, M.D

   Department Of Internal Medicine,combined military hospital,lahore

   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.

   References:

   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

   Conflict of Interest:

   None declared

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   Published August 27, 2008
2. Post-test probability only 16% for rapid HIV test

   • james r korb, md

   Southern California Permanente Medical Group
   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:

   None declared

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   Published August 21, 2008