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August 10, 1994

Potential Cost of Screening Surgeons for HIV

Author Affiliations

University of Chicago Chicago, Ill

JAMA. 1994;272(6):434. doi:10.1001/jama.1994.03520060032021

To the Editor.  —Although we found the article by Dr Phillips and colleagues1 interesting, we have several questions regarding their assumptions. First of all, were the correct costs for false-positive testing included? If one assumes the sensitivity and specificity of the tests cited in the article (99% and 99.9% for two of three enzyme-linked immunosorbent assay tests and a Western blot for confirmation), for every 100 000 surgeons tested (assuming a prevalence of 0.06%; data cited in the article), 59.4 true positives and 99 false positives would be detected. Thus, two thirds of the surgeons detected by even this careful scheme of testing would not have human immunodeficiency virus (HIV) infection. Alternatively, if a prevalence rate of 0.4% is assumed, 396 surgeons would be true positives and 99.6 surgeons (20% of the surgeons tested positive) would be false positives.Our analysis indicates that this article may have underestimated the

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