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Your info about ELISA accuracy is contradicting
May 24, 2007

Dear Dr. Pierone, now I am totally confused. Your information regarding the reliability of the ELISA test seems to contradict what is said by the US Centers for Disease Control and Prevention. According to them, current HIV-1 EIAs "can accurately identify infections with nearly all non-B subtypes and many infections with group O HIV subtypes." See this link:

www.avert.org/hivtypes.htm

But yet you say in your response to a poster on 8-29-03, "The standard ELISA test is very good for determining infection with the clade B strains of HIV that account for the vast majority of infection in the U.S." But you go on to say, "It is less reliable for establishing a diagnosis for group O and non-subtype B virus."

So which is it? Quite frankly, what you are saying doesn't make much sense. What you seem to be implying is that the U.S. HIV antibody test was developed with the assumption that Americans have never traveled outside the U.S.A. and had sex with a prostitute from a third world country. To me, this would be a dangerous assumption considering how well-traveled Americans are. An HIV antibody test restricted to the borders of the U.S.A. and western Europe would be naive and a public health hazard. I could become infected with HIV in Thailand with the E subtype but then 6 months later, test HIV negative on an American ELISA test. Then assuming I'm negative, I could then infect my wife or girlfriend or mistress or boyfriend or whomever. Then they could spread the virus with THEIR lascivious behavior and before you know it, the United States becomes as bad as Africa with their many subtypes and strains of HIV.

To me, it would seem plausible that the U.S. HIV antibody tests are more all-inclusive as the Centers for Disease Control and Prevention would say, primarily for the best interest of public health.

What are YOUR thoughts on this? Perhaps I misunderstood your response to the poster. Please correct me if I did. Thank you Dr. Pierone.

Response from Dr. Pierone

Hello, and thanks for posting.

Thanks for pointing out this inconsistency in the older post. If I were answering this question today, I would say "According to the CDC, current HIV-1 EIAs "can accurately identify infections with nearly all non-B subtypes and many infections with group O HIV subtypes.

Your point about the importance of being able to accurately diagnose all strains of HIV infection is well taken. The testing companies continue to tweak their methodology in order to not miss the less common subtypes. Progress has made and there is currently greater precision in these situations compared with older tests.



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