HIV-1 serologic test results for one million newborn dried-blood specimens: assay performance and implications for screening.

In a population-based national survey conducted in 1988-90, more than one million neonatal dried-blood specimens were tested for maternal antibody to human immunodeficiency virus type 1 (HIV-1). Enzyme immunoassays (EIA) and Western blot tests were performed in 20 state laboratories following standardized procedures. The observed predictive value of a repeatedly reactive EIA results closely coincided with that expected on the basis of manufacturer's estimates of test sensitivity and specificity for dried-blood specimens. Of the 2,845 EIA-reactive specimens tested by Western blot, 1,323 (47%) were positive, 1,270 (45%) were negative, and 252 (9%) were indeterminate. False-positive EIA and indeterminate Western blot results occurred at rates independent of seroprevalence. These data help characterize the results to be expected from screening of similar low-seroprevalence populations and constitute a base line for the detection of systematic testing errors.