Dr. Holodniy,

I've read many posts where people are asking about the possibility of HIV with respect to negative or undetermined testing, especially when P24 testing is involved. At the risk of sounding flattering, this site is best place for *any* questions to get answered, so I'd like to ask a question here and now that has gotten routinely shot down on the other sites (POZ, MedHelp, etc): Why isn't HTLV ever considered as an alternative diagnosis to HIV? Since HIV & HTLV share P24, since they are both retroviruses, since they both transmitted in the same manner, since they both cause very similar symptoms, why wouldn't people testing negative for HIV antibodies and/or somewhat reactive to P24 ever be considered for HTLV? The number of people infected with HTLV is astonishing for a disease that is never mentioned (almost in the ballpark of HIV infections, with many HIV patients co-infected with HTLV), and is especially high within the IV drug user community. Why can't doctors (present company excluded I hope) talk openly about HTLV? Ironically, the only person who has given the whole picture of HTLV is Rick Sowadsky on this site, who's not even a doctor (great thanks to Rick, since without his candor, I'd never know about HTLV). So I'd like to understand from your perspective please why this is - why is HTLV swept under the rug, so to speak? And, more importantly, what can we do to change that denial, so that HTLV is considered a public health issue as much we do for HIV, Hepatitis, etc?

Thank you in advance for your compassion & thoughts.

I have no issues with HTLV 1 and 2 testing. They are tested for in every donated unit in blood banks in the US. Clinical testing would have to be more nuanced, based on the clinical history, physical findings, and epidemiology (prevalence and incidence) in the specific community.