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To the Editor.—Although we agree wholeheartedly that identifying mothers infected with the human immunodeficiency virus 1 (HIV-1) to reduce vertical transmission can be implemented systematically as suggested by Drs Minkoff and O'Sullivan,¹ we do not agree that rapid HIV-1 antibody testing at the time a woman gives birth is the solution because of the way this practice would affect our obstetrics population. The rapid HIV-1 antibody test licensed by the Food and Drug Administration (SUDS, Murex Corp, Norcross, Ga) has stated sensitivity and specificity of 99.9% and 99.6%, respectively. Even with this superb performance, the positive predictive value (PPV) of a positive test result can exceed 50% only when the prevalence of HIV-1 infection exceeds 0.5%. Seroepidemiology data collected from our obstetrics population revealed an overall HIV-1 seroprevalence of 0.2% in 1992 and 0.1% in 1994. Thus, the PPV of a positive SUDS test result in our population could . . . [Full Text of this Article]

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The Case for Rapid HIV Testing During Labor
Howard Minkoff and Mary Jo O'Sullivan
JAMA. 1998;279(21):1743-1744.
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