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Rapid point-of-care HIV antibody test recommended in high-risk populations

Pai NP. Lancet Infect Dis. 2012;doi:10.1016/S1473-3099(11)70368-1.

Issue: March 2012

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Based on accurate oral fluid and whole-blood specimens, researchers recommend a rapid HIV antibody point-of-care test in high-risk populations.

However, in low-risk populations, the lower sensitivity and predictive value of the test in oral fluid specimens should be carefully reviewed, according to new findings from the McGill University Health Center and McGill University in Montreal.

“The accuracy of OraQuick Advance Rapid HIV-1/2 Antibody Test (OraSure Technologies) is within the 98% to 99% range, which is high for a test with an infectious disease component,” Nitika Pant Pai, MD, of the health center, told Infectious Disease News. “OraQuick can be recommended for self-testing initiatives in high-risk populations. In low-risk populations, we need to educate individuals on the possibility of false negatives. The inability of the test to pick up recent infection is low because of lack of antigen.”

Nitika Pant Pai, MD

Pai and colleagues aimed to compare the diagnostic accuracy and positive predictive value of OraQuick when used with oral fluid vs. blood-based specimens in adults. Data for the systematic review and meta-analysis were pooled from five databases of published work from January 2000 to June 2011.

Overall, specificity of the test was similar in oral fluid (99.74%; 95% CI, 99.47-99.88) and blood specimens (99.91%; 95% CI, 99.84-99.95). However, the test was 1.6% lower in sensitivity in oral fluid (98.03%; 95% CI, 95.85-99.08) vs. blood specimens (99.68%; 95% CI, 97.31-99.96).

The positive predictive value was similar for oral fluid (98.65%; 95% CI, 85.71-99.94) and blood specimens (98.5%; 95% CI, 93.10-99.79) in high-prevalence settings, whereas in low-prevalence settings, the positive predictive value was lower for oral fluid (88.55%; 95% CI, 77.31-95.87) than blood specimens (97.65%; 95% CI, 95.48-99.09).

Disclosure: This research was funded by the Canadian Institutes for Health Research (CIHR KRS 102067).

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