Aylin UĞURLU, Hilal KART, Hülya KOÇYİĞİT AKYÜZ
Baltalimanı Dergisi - 2026;2(1):20-25
Objective: To analyze the prevalence, causes, and clinical management strategies of false-positive results in HIV screening tests prior to elective orthopedic surgery in low-prevalence settings. Methods: A selective literature review was conducted in PubMed, Scopus, and Web of Science databases, covering publications from 2000 to the present. Approximately 30 sources were examined, with priority given to cohort studies, retrospective analyses, and current guideline documents (CDC, WHO) reporting screening results prior to elective surgery. Results: In low-prevalence settings, false-positive rates range from 0.11% to 0.67%, consistent with the 0.4%-1.3% range reported in general populations in low-prevalence regions. Primary causes include the limited specificity of fourth-generation immunoassays, biological cross-reactivity associated with conditions such as EBV, CMV, autoimmune diseases, pregnancy, vaccinations, and post-COVID-19 immune alterations, as well as technical errors and patient-specific factors relevant to orthopedic populations, including rheumatoid arthritis, chronic inflammation, advanced age, and anti-inflammatory medications. Clinical consequences encompass patient anxiety and stigma, surgical delays, additional costs, and disruptions in healthcare workers' risk perception. Confirmation strategies involve rapid HIV RNA nucleic acid testing (NAT) using two- or three-test algorithms adapted from CDC and WHO guidelines, and surgery proceeds without delay when the NAT result is negative. Conclusion: Although false-positive HIV screening results are infrequent in elective orthopedic surgery, they can be effectively managed through multidisciplinary approaches, rapid confirmation processes, and patient-centered counseling. Rationalizing screening policies in low-prevalence environments via risk-based approaches, institutional monitoring of false-positive rates, and staff training will safeguard patient safety, maintain surgical continuity, and enhance healthcare system efficiency. Future prospective studies specific to orthopedic surgery are needed to further validate the effectiveness of these strategies.
