Screening May Be Cost-Effective for Primary HIV

Two studies look at benefits of HIV testing in patients with viral symptoms

THURSDAY, Sept. 29 (HealthDay News) -- Screening symptomatic ambulatory patients for HIV has a 67% probability of being cost-effective, according to two papers published in the September/October issue of the Annals of Family Medicine.

Andrew Coco, M.D., M.S., of the Health Research Center, Lancaster General Hospital in Lancaster, Pa., and Emily Kleinhans of Goucher College, Baltimore, Md., used survey data from the 2000 National Ambulatory Medical Care and National Hospital Ambulatory Medical Surveys to identify a population of patients with one or more of 17 primary HIV symptoms including fever, pharyngitis and lymphadenitis. The data represent 90% of all US ambulatory care visits. The HIV disease prevalence rates for patients presenting with fever, rash and pharyngitis were 0.66%, 0.50% and 0.16%, respectively.

Coco also conducted cost-effectiveness analysis of a hypothetical cohort of over 3 million outpatients presenting with fever and other symptoms of viral infection. Three tests for HIV infection were used -- p24 antigen enzyme immunosorbant assay (EIA), HIV-1 RNA assay and third-generation HIV-1 EIA. The cost-effectiveness threshold was $50,000. Assuming a baseline prevalence of 0.66%, p24 antigen EIA testing cost $30,800 per quality-adjusted life-year gained. It identified 17,054 cases and avoided infection of 435 partners.

"Expanded testing for primary HIV infection could have a strong impact on curtailing the HIV epidemic and contribute greatly to achieving the CDC goal of reducing the annual number of HIV infections by 50% per year," Coco writes.

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