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MASS-HIV antibody testing...
Jun 10, 2007

Again, thanks so much for you tireless work here. I wish I could adequately convey just how much these forums have helped me deal with my illness.

I've been hearing a lot lately about various agencies "strongly recommending" that more and more people have HIV antibody testing.

I can totally understand starting to prioritize early identification as another "prevention" strategy towards controlling this epidemic.

I just believe that pushing too strong on specific HIV antibody testing could create a backlash, because the stigma is still just too great.

So this is my thinking, and if you would help me understand if I'm just missing something here...

Why don't health agencies "strongly recommend" that LABS add LYMP breakdown(CD4,CD3,CD8) testing to the normal hematology assay?

I have a yearly physical in which my Doctor orders a hematology assay that is already pretty detailed. Down to counting not just RBC and WBC, but also NEUT, LYMP, MONO, BASO, etc.,. So adding a deeper level of detail to further break down the LYMP numbers to CD3, CD4,and CD8 numbers shouldn't make the test cost prohibitive especially when you apply the whole economy of scale of making it "routine".

I understand that these tests wouldn't be as "conclusive" as an HIV antibody test, BUT they also wouldn't have the associated stigma of HIV antibody testing, and I honestly don't even see how it would require any kind of specific "secondary patient consent" similar to what HIV antibody tests have today, since it would just be a further level of detail added to existing testing strategy.

If these additional numbers were "out-of-range", and especially if they were progressively out of range over multiple tests, then it would be a GREAT way for the patients doctor to discuss the possibility of risk factors, need for further, more detailed, testing, etc.

To be honest, I would say that the vast majority of people ALREADY BELIEVE that their yearly blood work would somehow show if something was "wrong", so I can't even see how this new level of detail would be a hard sell.

I just think it would be a non-confrontational way to start the dialog of treating this epidemic sooner.

And it is a better way to bring the patient INTO the process of diagnosis without triggering the panic of the words: HIV AIDS

Response from Dr. Wohl

I feel the best way to reduce the stigma you describe is for HIV testing to come out of the closet. We should all be tested and many of us regularly. As many as 28% of those with HIV infection in the US do not know they are infected and about 40,000 people acquire the virus every year. This has got to stop and widespread testing will help. It will help people learn their status, it will help spread the word that HIV has not gone away, and it will help educate people who are HIV negative to stay that way to stay.

I share your concerns regarding the consequences of being diagnosed HIV-positive. Those who test HIV+ will unfortunately at times be forced to confront the ugliness of discrimination. I hope though that with the increase in people who know they are positive we will see less stigma as more of see that our friends, family, coworkers, etc, are living with the virus. We all need to advocate for acceptance at every level.

CD4 testing alone will lead to confusion. Many people can have a low CD4 during non-HIV illnesses. Many of these will worry needlessly if told their test is in the AIDS range. And what of all those who are HIV-infected but have relatively preserved CD4 cell counts? The strategy you describe would not identify such people.

We have tried a system of selective testing and it flunked. It is time to move on and opt-out testing as proposed by the CDC is a reaasonable response to an unreasonably persistant epidemic.

DW



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