Human immunodeficiency virus test evaluation, performance, and use. Proposals to make good tests better
J. S. Schwartz, P. E. Dans and B. P. Kinosian
Department of Medicine, University of Pennsylvania, Philadelphia.
Human immunodeficiency virus (HIV) tests are essential for detecting
asymptomatic infection and are helpful in confirming the diagnoses of
acquired immunodeficiency syndrome-related complex and acquired
immunodeficiency syndrome. Nonetheless, many aspects of their use remain
controversial, partly because of concerns about test accuracy. This article
reviews the scientific basis for the evaluation, performance, and use of
the most commonly employed HIV assays. Current test performance could be
improved by better standardization of test procedures and institution of
mandatory proficiency testing and licensure of clinical laboratories that
perform HIV testing. Test utility could be enhanced by sequencing tests
more appropriately and by interpreting test results in conjunction with the
clinical purpose for which the test is being used and the characteristics
of the population under study. Finally, HIV tests should be evaluated in a
manner that minimizes spectrum and referral bias and inadequate reference
standard confirmation, problems that have affected the evaluation of
current tests.
