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John H. Fitchen, MD; J. Richard George, PhD; Andrew S. Goldstein, MS
Epitope Inc Beaverton, Ore

JAMA. 1997;277(20):1592-1593.

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In Reply.

—We agree with Dr Ryder's conclusion that "a positive EIA and indeterminate Western blot may be merely a false alarm." Oral mucosal transudate and blood HIV testing are subject to outcomes that are uncertain and require follow-up testing to arrive at a definitive result. When indeterminate HIV test results are interpreted by experts, inferences about true HIV status may be drawn from the magnitude of the EIA test signal and from the nature (viral vs nonviral) of individual Western blot bands. Thus, the tone of the message during counseling might differ depending on whether the test result is likely to be a false alarm or is distinctly worrisome.

The predictive value of the "EIA component" of HIV testing may be of academic interest, but the clinically relevant factor is the full testing algorithm. Oral mucosal transudate testing never resulted in a false-positive outcome. Just as with blood, there are occasional . . . [Full Text PDF of this Article]

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