Human Immunodeficiency Virus Test Evaluation, Performance, and Use: Proposals to Make Good Tests Better

• Published in: JAMA : the journal of the American Medical Association Vol. 259; no. 17; pp. 2574 - 2579
• Main Authors: Schwartz, J. Sanford, Dans, Peter E, Kinosian, Bruce P
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 06-05-1988
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - diagnosis; AIDS; AIDS/HIV; Bioethics; Biological and medical sciences; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Mandatory Programs; Medical sciences; Medical technology; Risk Assessment; Sensitivity and Specificity; Serologic Tests; Tests; Virus Cultivation; Voluntary Programs; Human; Immunopathology; Virological exploration; Retroviridae; AIDS; Hemopathy; Serology; Immunological method; Infection; Virus; Viral disease; Diagnosis; Human immunodeficiency virus; Health Care and Public Health
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.1988.03720170050033

Human immunodeficiency virus (HIV) tests are essential for detecting asymptomatic infection and are helpful in confirming the diagnoses of acquired immunodeficiency syndrome—related complex and acquired immunodeficiency syndrome. Nonetheless, many aspects of their use remain controversial, partly because of concerns about test accuracy. This article reviews the scientific basis for the evaluation, performance, and use of the most commonly employed HIV assays. Current test performance could be improved by better standardization of test procedures and institution of mandatory proficiency testing and licensure of clinical laboratories that perform HIV testing. Test utility could be enhanced by sequencing tests more appropriately and by interpreting test results in conjunction with the clinical purpose for which the test is being used and the characteristics of the population under study. Finally, HIV tests should be evaluated in a manner that minimizes spectrum and referral bias and inadequate reference standard confirmation, problems that have affected the evaluation of current tests.(JAMA 1988;259:2574-2579)