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couples, partners of high risk patients) and others with a new sex
partner or STD.(MMWR 2002;51:736; MMWR 2002;57[RR-6]:7;
MMWR 2006;55:1269). Annual seroconversion rates are estimated as
follows: general population – 0.001%, military recruits – 0.04%, MSM
– 0.5% to 2% (higher among younger MSM), and injection drug users
in areas with high seroprevalence – 0.7% to 6% (Am J Epidemiol
1991;134:1175; JAIDS 1993;6:1049; Arch Intern Med 1995;155:1305;
Am J Public Health 1996;86:642; Am J Public Health 2000;90:352;
MMWR 2001; 50:440).
ALTERNATIVE HIV SEROLOGIC TESTS
IMMUNOFLUORESCENCE ASSAY (IFA): This is another method to detect
HIV antibodies using patient serum reacted with HIV infected cells. A
fluorochrome is used as the indicator method.
HOME KITS: HIV self test kit: (Home Access Health Corp., Hoffman
Estates, IL; 800-HIV-TEST) is sold in retail pharmacies, by phone order
(1-800-448-8378), and online (www.HomeAccess.com/). Cost of the
test is $50 for a 5 day report service or $60 for next day report service.
Blood is obtained by lancet, and a filter strip and then blot ted blood is
mailed in a protected envelope using an anonymous code. Home
Access’ tests use a double EIA with a confirmatory IFA. Sensitivity and
specificity approach 100%. The results are confidential, and counseling
plus referral is available by phone. In a study of 174,316 HIV home
sample collection tests in 1996 to 1997, 0.9% were positive and 97%
of users called for their results. (JAMA 1998;280:1699). Merits of this
type of home testing are debated (NEJM 1995;332:1296), but opinion
is changing toward more general acceptance (NEJM 2006;354: 437).
The FDA has more recently reviewed another home test in which
results are interpreted by the user. This would make home testing
available to consumers in a fashion similar to the pregnancy test. The
initial review was favorable (J Clin Microbiol 2006; 44:3472)
RAPID TESTS: There are six FDA-approved rapid serologic tests, listed in
Table 2-2, which show variations in the specimen type and CLIA
category (www.cdc.gov/hiv/rapid_testing):
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