Pai NP. Lancet Infect Dis. 2012;doi:10.1016/S1473-3099(11)70368-1.
Based on accurate oral fluid and whole-blood specimens,
researchers recommend a rapid HIV antibody point-of-care test in high-risk
populations.
However, in low-risk populations, the lower sensitivity
and predictive value of the test in oral fluid specimens should be carefully
reviewed, according to new findings from the McGill University Health Center
and McGill University in Montreal.
“The accuracy of OraQuick Advance Rapid HIV-1/2
Antibody Test (OraSure Technologies) is within the 98% to 99% range, which is
high for a test with an infectious disease component,” Nitika Pant Pai,
MD, of the health center, told Infectious Disease News.
“OraQuick can be recommended for self-testing initiatives in high-risk
populations. In low-risk populations, we need to educate individuals on the
possibility of false negatives. The inability of the test to pick up recent
infection is low because of lack of antigen.”
Nitika Pant Pai, MD
Pai and colleagues aimed to compare the diagnostic
accuracy and positive predictive value of OraQuick when used with oral fluid
vs. blood-based specimens in adults. Data for the systematic review and
meta-analysis were pooled from five databases of published work from January
2000 to June 2011.
Overall, specificity of the test was similar in oral
fluid (99.74%; 95% CI, 99.47-99.88) and blood specimens (99.91%; 95% CI,
99.84-99.95). However, the test was 1.6% lower in sensitivity in oral fluid
(98.03%; 95% CI, 95.85-99.08) vs. blood specimens (99.68%; 95% CI,
97.31-99.96).
The positive predictive value was similar for oral fluid
(98.65%; 95% CI, 85.71-99.94) and blood specimens (98.5%; 95% CI, 93.10-99.79)
in high-prevalence settings, whereas in low-prevalence settings, the positive
predictive value was lower for oral fluid (88.55%; 95% CI, 77.31-95.87) than
blood specimens (97.65%; 95% CI, 95.48-99.09).
Disclosure: This research was funded by the
Canadian Institutes for Health Research (CIHR KRS 102067).