Pustaka Ilmiah Universitas Padjadjaran

Abstrak

Screening and diagnosis of HIV-infection in Indonesia; one,two or three tests ?

Background : The use of serial tests for diagnosing HIV, as recommended in Indonesian guidelines, will lower the risk of false]positive results, but may increase costs, and delay or reduce uptake of HIV] treatment. Methods: We retrospectively examined the rate of false]positive results of initial HIV]tests for all subjects tested in the referral hospital for HIV in West]Java, Indonesia, between 2006 and 2008. We also calculated the positive and negative predictive value of single test results and dual]testing, based on sensitivity and specificity of commonly used methods and prevalence data from Indonesia. Results : Among 3121 subjects, 803 tested positive (25.7%). The initial rapid HIV]tests did not show a single false positive result, and no discrepancy was found between the second and third supplemental tests. Based on their high accuracy, most rapid tests carry a low risk of falsepositive results among risk groups. Dual testing algorithms almost eliminate the risk of falsepositive HIV]results, and are probably as accurate as three tests, even in low prevalence settings. Conclusion : Based on expected prevalence rates and the accuracy of methods used in Indonesia, one or two tests are usually accurate for HIV]diagnosis, especially for high risk populations. The possible implications and optimal conditions for more simple testing algorithms warrant further investigation.