Polymerase chain reaction for the diagnosis of HIV infection in adults: a meta-analysis with recommendations for clinical practice and study design

Article Abstract:

The polymerase chain reaction (PCR) does not appear to make an accurate enough screening test for HIV infection. PCR uses bits of HIV DNA and makes many copies until there is enough to detect. Researchers analyzed 96 studies evaluating the accuracy of PCR for diagnosing HIV infection. Accurate diagnosis of HIV infection in the better designed studies ranged from 83% to 100% and accurate identification of HIV-negative individuals ranged from 95% to 100%. Studies published since 1991 had lower accuracy rates than earlier studies, which suggests that refinements of the technology have not improved results. Based on all studies, the highest possible combination of these two factors was 98%. However, this means that in populations with a 1% probability of HIV infection, a positive PCR test will be correct only one-third of the time. Tests in standard use have accuracy rates of 99% or more. PCR may help when other tests are indeterminate or when early detection is important.

Diagnosis, Polymerase chain reaction

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Screening surgeons for HIV infection: a cost-effectiveness analysis

Article Abstract:

A national screening program to detect HIV infection in surgeons may not cost-effectively prevent HIV transmission. Researchers used a decision model to analyze the cost-effectiveness of a program to screen surgeons for HIV and to prohibit those who are infected from performing invasive procedures. A single, national HIV screening would identify approximately 137 HIV-infected surgeons. It would prevent an estimated 4.3 HIV cases in patients treated by infected surgeons and less than 1 HIV case in the sexual partners of infected surgeons. The program would cost approximately $8 million for screening, $3 million for early medical treatment for HIV infected surgeons, and $44 million for the decrease in services provided by surgeons who tested HIV positive. The cost of a single national screening program is estimated at $458,000 per year of life saved, which is considerably more expensive than other health interventions.

Economic aspects, Testing, Surgeons, HIV testing, HIV tests

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Monitored isoniazid prophylaxis for low-risk tuberculin reactors older than 35 years of age: a risk-benefit and cost-effectiveness analysis

Article Abstract:

Closely monitored preventive treatment with isoniazid may be a cost-effective way to reduce health care costs associated with potential infections in older low-risk patients who have a positive tuberculin test reaction. However, the increases in life expectancy associated with this tactic appear to be minimal. A statistical model was used to evaluate cost-effectiveness and life expectancy in treated low-risk 35-, 50-, and 70-year-old patients with positive tuberculin test reactions. The overall cost savings in the US would be $2.11 billion. Gains in life expectancy ranged from 3.1 days to 10.0 days.

Middle aged persons, Health aspects, Care and treatment, Usage, Tuberculosis, Cost benefit analysis, Isoniazid

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