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Follow Up: ELISA/good for all strains of HIV?
Sep 4, 2003

Dear Doctors,

thanks for your great work. It is highly appreciated!

In response to a recent question about HIV serology [versus viral diversity] Dr. Pierone answered:

"(..) It is less reliable for establishing a diagnosis for group O and non-subtype B virus. If there is a reason to suspect infection with one of these strains (recent trip to Africa with unprotected sexual exposure) then a Amplicor (version 1.5) viral load test can be done to detect other strains."

I find this rather disturbing... I knew that 3rd gen antibody tests may have problems with rare types in *primary* infection, but i thought that after 6 to 12 months antibody tests were the most sensitive tests, even/especially for the "rare strains".

So, what's the best testing protocol for testing someone with suggestive symptoms and negative antibody tests after window period? What does it need to rule out HIV infection in such persons once and for all? Or, to turn it into a more pragmatic question: how many cases do exist were both antibody and PCR failed and what was the consequence of these cases? Oh, and what's your opinion about regular CD4 testing in negative persons? Is this useful or should it be avoided?

thank you! Joe

---- Just some background info about my case: After intimate contact with a girl (who turned out was an ex cocaine etc. user) in spring 2002 i had all kinds of ARS like symptoms incl. lymphopenia and now i have swolen tender lymph nodes and fatigue.

However all HIV (and other STD) tests (antibody+p24 till 13 months, PCR HIV1+2 RNA/DNA, Ultrasenitive. p24, viral Cultures) were negative but i can't get rid of the idea that due to some wild mutation or recombination a new undetecable virus developed and got into my system.

Anyway... i am doing sports now and i receive b12 vitamin shots to combat fatigue... Especially the sports works very well and gives back confidence in my body. I even adjusted to the lymph node problem and i am in good medical care with regular check ups.

So, while i have the lingering doubts about my status, i am no wreck anymore... partially because of you, because it's good to know that life would not end in case of positive diagnosis.

Response from Dr. Pierone

You should try to get rid of the idea that due to some wild mutation or recombination a new undetectable virus developed and got into your system. It didn't. The vast, vast majority of HIV infections in the U.S. are picked up on standard testing and you have gone above and beyond the call of duty in HIV testing.

However, if you happen to be on a working tour of commercial sex facilities in the Cameroon (Africa)...

Actually, this forum is on starting treatment and all future questions regarding recombinant, mutated, or alien strain testing will be referred to the transmission forum. thanks, GP



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