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A Little Honesty Perhaps?
Jan 14, 2007

Ever since I tested positive and have been under medical care I have not been impressed with the level of honesty with the medical profession about HIV. Both the physicians I have seen were arrogant bastards who seemed to view themselves as Gods, loathed to answer serious questions about my treatment, and viewed my questions as a nuisance. I have done some reading about many aspects of HIV care, and it seems there is little you, or any other MD, can say with any accuracy about HIV. Yet, even reading over posts on The Body, much of the same is apparent. For example, can you answer, HONESTLY, the following questions:

1) you claim that the HIV antibody test is 99.9999999% accurate, yet the first thing the MD did when I went for care was to perform the antibody test over again. If it is soooooo accurate, why perform it over again?

2) You claim that viral load and T-cell count are linked, yet my viral load seemed to remain stable at around 40k, yet my t-cells were decreasing. I asked my MD about this and she just said Oh, you must have had a bad reaction to the virus. What the hell is that supposed to mean? Isnt it true that the PCR test does not even check for viral particles in the blood but multiplies pieces of DNA that the PCR machine believes are viral particles?

3) You say that a t-cell count of <200 is an AIDS diagnosis, yet studies have been done that show many, MANY, things, including stress, other medications, and malnutrition can reduce t-cells below 200. My t-cells were below 200, and I felt great, had no more colds or flu than anyone else had in my circle, and did not even have a single swollen lymph gland. All my lab results were perfectly normal, except for the t-cell count. Both the MDs said I was dying, yet there seemed to be NO proven evidence of this. Explain?

4) Has there ever been a study that examines the life span of so-called positive patients that were not living under 3rd world conditions, or, in the case of the US and the EU, were not drug-addicts, alcoholics, or sex addicts who were constantly infected with this or that STD? It seems to me there is a clear correlation between malnutrition and exposure to parasites in the third world, abusive health destroying behavior in the first, and HIVs ability to cause disease. If you have never examined how healthy people respond to HIV, how can you say that the virus is in all cases lethal?

5) MDs claim that human beings are supposed to have a t-cell count between 500-1200, yet studies published in JAMA clearly indicate that this is just an average, and that there is wide variation is this figure. Why do you then use this figure to place patients on highly toxic drugs when you dont know what the patients own individual t-cell range is? When I first had my t-cells checked, it was around 400. Can you tell me with certainty 10 years ago, long before I was HIV positive that my t-cells were around 400?

I bet you will ignore this post.

I think one of the best techniques for teaching people safe sex is to inform them, if they should become HIV positive, that they will then be forced to deal with a bunch of arrogant bastards who seemed to be more concerned with maintaining their delusions of grandeur than talking honestly and openly with their patients about how little they know about HIV and these tests that they rely on as if God had passed them down from the mount.

Response from Dr. Young

Whoa, you're an angry person. I can speak for all of our writers here at TheBody.com's forums in that we all answer questions as honest and sincere healthcare providers.

You've lost your bet. I've not ingored your post.

So let me try to answer your questions HOSESTLY (your emphasis):

1) The HIV antibody tests (ELISA plus western blot) are indeed very highly accurate (specific and sensitive), but human-run testing may not be (mistakes in handling, labeling, etc). Because your doctor cares enough to be sure that your diagnosis is correct, he or she repeated the test.

2) You're misinformed. Just because your viral load hasn't changed doesn't mean that the virus in your blood can't and doesn't cause injury to CD4 counts. The HIV viral load PCR tests looks for RNA (by the way, not DNA) in the sample of blood obtained. The way that this is done is to isolate viral particles first, then to disrupt the viral particles to release their RNA. Since there is a constant amount of RNA in each viral particle, the amount of RNA detected is proportional to the number of viral particles.

3) AIDS is defined operationally by epidemiologists to be present when either the CD4 count is below 200 (or 15%) or when any one of a group of indicator illnesses is present. Many things can and do influence CD4 counts, but in general, stress (or medications or malnutrition) alone does not lower such levels from normal to below 200.

As for your doctors saying that you're dying, in a population of HIV infected persons, untreated HIV does result in medical complications and death. This is why we are so concerned about one's CD4 count. You may be asymptomatic (this is your key, and undeniably central focus), but with counts below 200, you are at risk of life-threatening complications.

4) There are plenty of studies of persons living in US and Europe (so-called not third world conditions) that speak to life expectancy. These include our analyses of the CDC's HOPS study and the EUROSIDA group. (By the way, I'm not sure where you come away with the impression that ALL (my emphasis) cases of HIV are lethal; even without treatment, there are those who do not experience disease progression- the "long-term non-progressors").

5) Medical and laboratory science uses studies of uninfected persons to determine what the normal range of CD4 counts is (it can actually be as low as 350, not the 500 value that you cite). We actually don't use the normal CD4 count range alone as the basis for deciding on whether or not to initiate HIV treatments, but rather epidemiologic studies which show that there is an increased risk of HIV-related, symptomatic complications once the CD4 counts are below 350.

Consistent with this, it's entirely possible that your CD4 count before HIV could well have been 400- a normal value. Can I say this with certainty? Of course not.

6) Lastly, I hope that these replies answer some of your concerns. BY



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