Re: Distinguishing between true and "official" HIV infection 27 June 2003
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Brian T Foley,
HIV Researcher
Los Alamos National Lab, Los Alamos NM 87545

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Re: Re: Distinguishing between true and "official" HIV infection

The Perth group asks:
"Do patients really play a role in interpreting their own tests?"

And my answer is that of course they do in most cases, and they always should. The patient always knows more about the patient's history than the doctor does. An accurate diagnosis depends on more than test results, it also requires putting those results into the context of the whole picture. For one example: A person with weight loss could have an eating disorder, could have a lack of money to buy food, could be on a diet, or could have any number of other reasons for experiencing weight loss. The doctor can't go back in time and observe the patient over the past 2 months and see what he or she ate. The patient has to be the one to help the doctor understand what the cause of the weight loss might be.

Likewise, for HIV antibody testing, the person being tested knows more about their history of sexual activities, IV drug use and needle sharing, and transfusions than the doctor does (unless the doctor was the same one who gave the person the transfusions and the person was unconscious and not told about the transfusions). I have heard horror stories from many people who were misdiagnosed because they either did not give the doctor full details pertaining to their condition, or they gave details but the doctor chose not to pay attention to them. In one such case, an attractive young woman employed in the fasion industry nearly died from a ruptured appendix because the doctor assumed the woman must be sexually promiscuous and that pelvic inflamatory disease was the cause of her pain. This doctor just could not believe that this woman was not sexually active and he also failed to believe her descriptions of the severity of the pain.

The Perth group claims that a Phair et al paper stated that one strong western blot band was "proof" of HIV infection.
Phair J, Jacobson L, Detals R, Rinaldo C, Saah A, Schrager L, et al.
Acquired Immune Deficiency Syndrome Occuring Within 5 Years of Infection with Human Immunodeficiency Virus Type-1: The Multicenter AIDS Cohort Study.
Journal of Acquired Immune Deficiency Syndromes 1992;5:490-496

They go on to question how many of these patients with only a single band were truly infected. My question would be "How many, and what percentage of the patients in this cohort actually had only one strong band?". It is my understanding that almost all HIV-infected people produce strong immunological responses to many HIV proteins during the course of their infection, and almost none (perhaps less than 2%?) produce an immunoglobulin response to only one of the HIV-1 proteins. Many denialists like to talk about the indeterminate test results. They fail to mention that almost all people who experience such results either:
1) go on to produce strong reactions to many HIV proteins at a later time point, indicating that they were recently infected prior to the indeterminate result and had not yet raised antibody responses to more HIV proteins. or
2) go on to a negative test or more indeterminate results, indicating that they are not producing more anti-HIV antibodies over time, and are therefor most likely not truly infected.

Also, I doubt that the Phair paper stated that a single western blot band was "proof" of HIV infection. A single band may have been all that was required for enrollment into the study, but scientists rarely speak of "proof" of anything.

Competing interests:   None declared