CURTAILING THE HIV EPIDEMIC WITH EXPANDED TESTING FOR PRIMARY HIV INFECTION OF PATIENTS WITH ACUTE VIRAL ILLNESS SYMPTOMS
Expanded testing for primary HIV infection among patients with fever or other viral symptoms may be a good expenditure of healthcare resources according to a cost-effectiveness analysis of three tests for primary HIV infection. The researcher found expanded testing among a hypothetical cohort of 3 million patients with fever and other viral symptoms, regardless of HIV risk factors, using the p24 antigen EIA test would identify 17,054 cases and avoid infection in 435 sexual partners. Of the three tests examined, the author found the p24 antigen EIA to be the most cost-effective for expanded testing, and also found this test to have the lowest rate of false-positive diagnoses. The author asserts that expanded testing for primary HIV infection could have a large impact on curtailing the HIV epidemic in the United States. They point out that the cost-effectiveness of this testing compares favorably with widely-accepted screening programs such as colon cancer, annual pap smears in HIV-infected women and breast cancer.

In a related study also in this issue, the same researcher developed prevalence estimates of primary HIV infection for patients seeking care for fever, rash, sore throat all symptoms consistent with primary HIV infection. Analysis of data from the 2000 National Ambulatory Medical Care and National Hospital Ambulatory Medical Surveys found patients complaining of fever and other visit reasons consistent with primary HIV infection, regardless of risk factors, had a disease prevalence of 0.66 percent, those with rash had a prevalence of 0.5 percent, and those with pharyngitis had a prevalence of 0.16 percent. The author asserts that these estimates can aid with development of clinical testing guidelines and clinical decisions around testing for acute HIV infection.

An accompanying editorial to these artic
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Contact: Kristin Robinson
kristinr@aafp.org
913-906-6000
American Academy of Family Physicians
27-Sep-2005

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