Rapid HIV Testing Is Not Without Its Flaws

Policy statements calling for expanded HIV testing in the U.S. rely heavily on OraSure rapid saliva and blood testing because the standard two-visit ELISA/Western blot sequence is considered too cumbersome for most settings. However, point-of-care rapid testing has accuracy problems and may also have follow-up problems, as several studies made clear this year.

A large study of an opt-out approach to HIV screening in a Washington DC emergency department (ED) found 26 of 2486 (1%) patients reactive on oral swab testing (AIDS Clin Care Jan 14 2008). However, only 13 (50%) of those patients returned to the hospital or a local free clinic for confirmatory testing. Nine had reactive Western blots, and four were confirmed to have false-positive res…