Screening and diagnosis of HIV-infection in Indonesia: one, two or three tests?
OBJECTIVE
to examine among high-risk populations or patients with signs or symptoms suggesting HIV-infection, two tests or even one single test might be sufficiently accurate for diagnosis of HIV in a hospital setting in Indonesia.


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 were 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 false-positive results among risk groups. Dual testing algorithms almost eliminate the risk of false-positive HIV-results, and are probably as accurate as three tests, even in low prevalence settings.


CONCLUSIONS
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.
Indrati
Agnes R
AR
Department of Clinical Pathology, University of Padjadjaran/Hasan Sadikin Hospital. Jl. Pasirkaliki no. 190, Bandung 40151, Indonesia. agnesariantana_sppk@yahoo.co.id
van Crevel
Reinout
R
Parwati
Ida
I
Tjandrawati
Anna
A
Noormartany
Kurmalawati
July
J
D015492:AIDS Serodiagnosis / Q000379:methods*; D004797:Enzyme-Linked Immunosorbent Assay; D005189:False Positive Reactions; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D007118:Immunoassay; D007214:Indonesia / Q000453:epidemiology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity