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Re: Getting Married. Subtype E virus
Nov 27, 2003

Dear Dr. Pierone,

Thanks for you answer to my recent question. My follow-up questions are: Which test(s) can I take to conclusively rule out HIV-1 CRF01_AE infection as best as modern medicine can? Or have I done enough already? Are the standard commerical antibody tests used in the U.S. identical to the ones used in Thailand to detect CRF01_AE there or are the commercial antibody kits "modified" in Thailand to screen for the AE clade? (I have not been able to find much literature online that would address my questions). Thank you again in advance.

*************PAST QUESTION: Dear Dr. Pierone, I am getting married very soon to someone I never had physical contact with. So, I am very concerned that I may be HIV-infected and may infect my wife-to-be. My case is as follows: I had 3 different "low risk" encounters in Thailand in 2002. Consequently, I decided to get tested for HIV. I took (1) an ELISA HIV-1&2 test 10 weeks following exposure, (2) an ELISA HIV-1&2 9 months following exposure, and (3) an EIA HIV-1 11 months following exposure. All the tests were performed in 2003 and they all came back negative. However, now that I found out that the prevailing HIV clade in Thailand is "subtype E", I am very concerned that all these tests may have not been adequate to detect subtype E antibodies. Can you please tell me if these tests are adequate for my case? Do I need to take further tests of different kinds? If so, which tests do you recommend? Many many thanks. Andy ******** ANSWER: The HIV tests that are used now (2003) are very accurate for diagnosing subtype E infections. Actually subtype E no longer exists but has been reclassified as CRF01_AE. This new classification reflects that understanding that this genetic subtype is in reality a virus produced by recombination of 2 other subtypes. No matter, the test works well, so good luck in your upcoming marriage.(END)*************

Response from Dr. Pierone

You have already conclusively ruled out infection by having the standard antibody tests for HIV infection. Where a lot of confusion comes up is that older viral load testing (Amplicor version 1.0) was less able to quantify viral levels in non-B clades. The newer version 1.5 does a good job of quantifying non-B virus.

A study on recently-HIV-infected military personnel showed that standard EIA with Western blot confirmation effectively diagnosed HIV infection (AIDS 2003; 17 (17):2521-2527). In this study there were 17 servicemen that acquired CRF01_AE. 13 of these 17 were stationed in Thailand and reported exposure to commercial sex workers. So standard testing works well in your situation. Best of luck.

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