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Some Real Numbers, Please!
Nov 2, 1998

I have heard so many different numbers of rare cases/exceptions to the rules that I would like to know your take on a few. The first in all the literature available, how many cases of people have taken longer than the six month window period to seroconvert? Second, how many people still contract HIV through receiving blood transfusions even with current testing procedures? Third, really, how many people in the U.S. have contracted the HIV II strain? Fourth, is a PCR Antigen test better/more accurate at detecting HIV than antibody testing or just quicker? (Percentages, please) I believe that a lot of readers would like these answers as well. Please, don't estimate or sugar coat, tell us what you know! Thanks.

Response from Dr. Holodniy

Answers to questions:

1. > 6 month seroconversion = < 50 last 10 years (difficult to extract from the literature because of different definitions and this includes those who never had detectable antibodies)

2. transfusion related HIV infection. Again hard to get accurate reliable numbers. However, in a 1993 study published in 95, assuming 12 million units transfused/yr in the US, between 18-27 HIV infected units and therefore infections might be expected. With the addition of p24 antigen testing (for early acute infection detection) in 1995, the rate would drop to about 10-20/year. The risk of acquiring HIV infection by transfusion is about 1 in 450,000-660,000.

3. HIV-2 cases in the US. 1996 CDC data indicates 65 documented cases in the US. Almost all from east coast states. At least 45 born in West Africa (many of the rest of the 65 country of origin was not reported).

4. No such thing as PCR antigen test. PCR is a technique used to detect presence of the virus, either in the plasma (viral load), or in blood cells (HIV DNA PCR). These tests are usually positive in a few days to couple of weeks after acute infection. P24 antigen is a blood test which measures the amount of core protein of the virus present. It will be positive early like the other two tests. It, however, disappears usually within a month after infection. This is right about the time antibody tests usually will become positive. So by one month after infection, > 99% of patients will have positive viral load tests. Elisa antibody tests are in the 50-70% range, increasing to 95% by 3 months and 99.99% by 6 months. Hope that's not sugar coated!!!

MH



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