Raboud J M, Sherlock C, Schechter M T, Lepine D G, O'Shaughnessy M V
Department of Health Care and Epidemiology, University of British Columbia, Canada.
J Clin Microbiol. 1993 Sep;31(9):2298-302. doi: 10.1128/jcm.31.9.2298-2302.1993.
Data from two seroprevalence studies and one comparative study of confirmatory algorithms were used to compare the costs and sensitivities of six algorithms for determining seropositivity to human immunodeficiency virus (HIV). We evaluated confirmatory strategies by using the CBC Recombigen HIV enzyme immunoassay (EIA; Cambridge BioScience, Worcester, Mass.) and immunoblotting followed by radioimmunoprecipitation assay to confirm indeterminate immunoblotting results with and without pooling of samples during screening. The least expensive algorithm was that in which sera were pooled during screening and EIA was used to confirm positive test results. The cost savings associated with this confirmatory test were greater when the prevalence of HIV infection was higher. Savings from pooling of sera for screen testing diminished as HIV prevalence increased. The sensitivity and specificity of EIA with respect to immunoblotting and radioimmunoprecipitation assay were estimated to be 0.9992 and 0.9977, respectively. We found that the implementation of pooling during screening and the use of EIA as the confirmatory test do not affect the statistical reliability of estimates of seropositivity but do result in considerable cost savings.
两项血清阳性率研究和一项确证算法比较研究的数据，被用于比较六种确定人类免疫缺陷病毒（HIV）血清阳性的算法的成本和敏感性。我们采用CBC重组HIV酶免疫测定法（EIA；剑桥生物科学公司，马萨诸塞州伍斯特）及免疫印迹法，随后用放射免疫沉淀试验来确证不确定的免疫印迹结果，评估了在筛查期间有或无样本合并情况下的确证策略。成本最低的算法是在筛查期间合并血清并用EIA来确证阳性检测结果的算法。当HIV感染率较高时，这种确证检测带来的成本节省更大。随着HIV感染率的增加，用于筛查检测的血清合并所节省的成本减少。EIA相对于免疫印迹法和放射免疫沉淀试验的敏感性和特异性估计分别为0.9992和0.9977。我们发现，在筛查期间实施样本合并并使用EIA作为确证检测，不会影响血清阳性估计值的统计可靠性，但确实能节省可观的成本。
