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Comments on the Recent Clinical Guidance Statement on HIV Screening
- Amir Qaseem, MD, PhD, MHA;
- Paul Shekelle, MD, PhD; and
- Douglas K. Owens, MD, MS
- From American College of Physicians, Philadelphia, PA 19106; RAND, Santa Monica, CA 90401; and Stanford University, Stanford, CA 94305.
IN RESPONSE:
We thank Drs. Van Allen and Kohlwes and Dr. Holtgrave for their comments regarding the American College of Physicians' recent clinical guidance statement on screening for HIV. Drs. Van Allen and Kohlwes are concerned about the potential for false-positive test results with widespread screening. Their example notes a specificity of 99.99% and estimates a substantial number of false-positive test results. In well-controlled testing programs using traditional HIV tests (enzyme immunoassay followed by Western blot) (1), the specificity of the sequence of antibody tests is as high as 99.9994% (1); therefore, false-positive results will be rare and far fewer than in their example. However, the specificity of rapid HIV tests may not be as high as that of traditional testing, and as we noted in our guidance statement, relatively high false-positive rates have been reported with an oral rapid test (2). We share the concern of Drs. Van Allen and Kohlwes about the impact of false-positive results. Patients and clinicians should be aware that HIV results with rapid tests are preliminary and must be confirmed with traditional antibody testing. The benefit of rapid testing is that more patients receive their test result.
We thank Dr. Holtgrave for the clarification about the results of his work. We agree with him about the importance of independent literature reviews in the development of clinical guidelines. In our clinical guidance statement, we used literature reviews prepared independently from our committee by the U.S. Preventive Services Task Force (3, 4) and the Centers for Disease Control and Prevention (5). Current evidence has not shown targeted screening to be successful in reducing transmission of HIV in the United States or identifying patients early in the course of disease. We await evidence demonstrating the benefits of targeted screening and, until then, recommend adoption of routine screening for HIV. We also note that the cost-effectiveness of HIV screening was only 1 of several factors that we considered in making our recommendation for routine screening.
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
