Measurement of the False Positive Rate in a Screening Program for Human Immunodeficiency Virus Infections

In a program screening civilian applicants for U.S. military service for human immunodeficiency virus (HIV) infection, we studied the frequency of false positive diagnoses retrospectively among applicants seropositive for HIV in a subpopulation with a very low prevalence of infection. That subpopula...

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Vydáno v:	The New England journal of medicine Ročník 319; číslo 15; s. 961 - 964
Hlavní autoři:	Burke, Donald S, Brundage, John F, Redfield, Robert R, Damato, James J, Schable, Charles A, Putman, Pamela, Visintine, Robert, Kim, Howard I
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Boston, MA Massachusetts Medical Society 13.10.1988
Témata:	Acquired immune deficiency syndrome Acquired Immunodeficiency Syndrome - diagnosis Acquired Immunodeficiency Syndrome - epidemiology Adolescent AIDS Armed forces Biological and medical sciences Cloning Disease control Enzyme-Linked Immunosorbent Assay Enzymes False Positive Reactions Female Health care HIV HIV Seropositivity - diagnosis HIV Seropositivity - epidemiology Human immunodeficiency virus Humans Immunoassay Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunoglobulins Immunology Immunopathology Infections Laboratories Male Mass Screening Medical sciences Medical screening Medical tests Military Personnel Military service Polypeptides Population density Public health Quality control Retrospective Studies United States Western blotting United States Human Immunopathology False positive United States AIDS Hemopathy Serology Military service North America Epidemiology Infection Screening Viral disease America Public health
ISSN:	0028-4793, 1533-4406
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Shrnutí:	In a program screening civilian applicants for U.S. military service for human immunodeficiency virus (HIV) infection, we studied the frequency of false positive diagnoses retrospectively among applicants seropositive for HIV in a subpopulation with a very low prevalence of infection. That subpopulation was defined as consisting of all applicants tested between October 16, 1985, and June 30, 1987, who were young (17 or 18 years of age) and resided in a rural county in a state with a low incidence of reported acquired immunodeficiency syndrome (n = 135,187). Serum specimens from 15 applicants positive for HIV in this low-prevalence subpopulation were retrieved from a serum bank and retested by two Western blot methods, radioimmunoprecipitation, and an immunoassay constructed from a molecularly cloned and expressed viral envelope polypeptide. Fourteen of the 15 samples were unequivocally positive on all retest assays, and 1 was negative. Thus, the measured rate of false positive diagnoses in this program was 1 in 135,187 persons tested. Factors important in achieving a low false positive rate were a redundant, multistep testing algorithm, conservative criteria for interpreting Western blots, the requirement that a second, newly drawn serum specimen be tested for verification before a diagnosis of HIV was considered established, and tight quality control of laboratory testing procedures. We conclude that a screening program for HIV infection in a low-prevalence population can have an acceptably low false positive rate. (N Engl J Med 1988; 319: 961–4.) OVER 1 million persons in the United States are infected with the human immunodeficiency virus (HIV). 1 Routine testing for HIV, with counseling of those who test positive, has been advocated as an effective public health response to the epidemic. 2 There is general agreement that testing may be appropriate for groups thought to be at high risk for infection, such as homosexual men, intravenous drug abusers, and patients of venereal-disease clinics. 3 However, concern has been expressed about the value of routine HIV testing among groups thought to be at lower risk, such as persons applying for marriage licenses, pregnant women, immigrants, . . .
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23
ISSN:	0028-4793 1533-4406
DOI:	10.1056/NEJM198810133191501