Re: Answers for Nicholas Bennett 1 October 2004
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Nicholas Bennett,
Infectious Disease Postdoc/Clinician
Department of Pediatrics, University Hospital, Syracuse NY

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Re: Re: Answers for Nicholas Bennett

I am forced to break my vow of silence with Mr Russel to point out that the cases of cross-reactivity with TB antigenes, and indeed if one looks at the literature practically all of the "70 different conditions", almost no cases were actually false-positive HIV diagnoses.

They were, in most cases, only ELISA positive (screening) and Western Blot negative or indeterminate (confirmatory). The last time I reviewed the literature, admittedly some years ago, the only situation in which I found that the papers actually supported what was being claimed by the AIDS-dissidents was a small series of hepatitis patients who were indeed diagnosed false-positive by serology.

The message "Do not perform screening ELISAs alone" has been twisted to mean "HIV tests are meaningless". I freely admit that in some areas in the developing world confirmatory tests are not available, but these are usually performed for screening purposes (e.g. blood donation) and not epidemiological surveillance. In addition this situation has forced the development of much improved rapid-screening tests in recent years.

Mr Russel can quote others until the cows come home, but the fact of the matter is that, most infectious disease clinicians I've met and worked with are (a) aware of the limitations and (b) know they don't usually apply.

Dementia may not be due to immune-suppression, but HIV infects CD4 glial cells which can result in neuronal death, weightloss is likely CMV related, and KS is certainly immune related. To say that "KS is common among homosexual AIDS patients" as evidence that it is common highlights the problem of misinformation, since these patients were originally spotted because of the usual rarity of KS! Mr Russel also implies that malaria in an AIDS-defining condition in Africa, when it is not. In fact, since most of the disease of malari is due to immune reactivity, malaria in HIV infected people tends to be somewhat better, and in fact the immune stimulation of acute malaria might even be helpful.

Field's is not so much a textbook as a review series: it supplies all the original references which I check before using them. It rather neatly organises the evidence far better than my own PubMed searches. If Mr Russel would kindly provide the reference from 1976 that shows anyone working on HTLV-1 had discovered ATL. The only ones I can find refer to cases diagnosed in 1976 (but the published literature of the time is from 1977). Since HTLV was derived from cells of these patients, one finds it hard to believe that HTLV came first.

Competing interests: None declared