The Cost-effectiveness of Voluntary Counseling and Testina of Hospital Patients for HIV

To the Editor.  —We read with interest the recent article by Dr Lurie and colleagues.¹ The two objectives of that study were (1) to evaluate the cost-effectiveness of routine screening of patients for human immunodeficiency virus (HIV) infection to avert health care worker infection, and (2) to assess the cost of identifying previously undiagnosed patients infected with HIV. We have several reservations regarding the methods and conclusions of the study, particularly in reference to their first objective. Of most concern, their decision analysis ignores the existence of universal precautions, which were carefully designed to prevent HIV infection as well as other virulent and readily transmissible agents such as hepatitis B virus, hepatitis C virus, hepatitis D virus, cytomegalovirus, and Mycobacterium tuberculosis. Whether a patient is found to be HIV-infected or not should have little or no influence on transmission if universal precautions are adequately used for all patients. In