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In Reply: Dr Guinn and Mr Zdeb raise important points to consider. The CDC formerly recommended against informing patients of an HIV-positive test result until it was confirmed. However, in 1998, the CDC recommended giving preliminary results from rapid tests because many HIV-infected persons did not return for the results of conventional tests.¹

HIV test technology is extremely reliable. A study of blood donors found that after confirmatory testing with Western blot, the false-positive rate was 0.0004%, and this can be lowered by the use of subsequent RNA testing.² The observed rapid test specificity (99.98%)³ is higher than that cited by either Guinn or Zdeb. A screening test's predictive value is also a function of disease prevalence, but Zdeb may also understate HIV prevalence in the United States.⁴ Thus, there will be fewer false-positive results and a higher positive predictive value with HIV screening than the writers suggest, although some . . . [Full Text of this Article]

Lawrence O. Gostin, JD, LLD
gostin@law.georgetown.edu
O’Neill Institute for National and Global Health Law
Georgetown University Law Center
Washington, DC

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