|viral load vs. antibody tests
Dec 31, 2003
Hey. I just wanted to express my frustration, and get your opinion about something. I got very ill last summer, and saw my primary care doctor, who was aware of my sexuality, etc, and who had been giving me an HIV-antibody test every 6 months (on my request) previously. He dismissed my flu-like symptoms, etc, by saying it might just be a stomach flu, and said I should just do clear liquids for a day, and then try to start eating again. I asked him to do another HIV-antibody test that day, so he did. 3 days later, I had just gotten much worse, so I went to the hospital, unable to eat, drink, or basically stand up. They tested me for everything possible. When the HIV-antibody test my doctor had given me arrived back during the second day of my hospital stay, it was negative. But my test for cryptosporidiosis had come back positive, so the doctors took blood for an HIV viral load test. This viral load test came back at 130,000. I realize that the body takes time to create antibodies, but I found it startling that if someone had not gotten as sick with an opportunistic conversion illness like I had, they would have received that HIV-antibody negative test, and probably not gone back for 6 months. Because of my illness, and the viral load test, I was able to start medicine DURING sero-conversion, not AFTER, which saved much of my basic cellular immunity. I would encourage anyone who has any reason to believe they may have been exposed at all to spend the extra few dollars on a viral load test, as opposed to the antibody test. I was so frustrated at what had happened, and felt so lucky, but cannot imagine all of the people who receive negative antibody tests and go around having sex believing they are negative, especially with all the men who will readily bareback if someone says they are negative. It seems to me that the antibody test should be an outdated method of detecting HIV infection, and is irresponsible of primary care doctors. Perhaps the spread of HIV from people who do not realize they have it would be somewhat suppressed. Please let me know your thoughts on this. Thanks.
| Response from Dr. Frascino
Sorry to hear about your horrendous experience. But I can't agree with your conclusions. Tests for viral load (PCR DNA or PCR RNA) are not considered to be more accurate than routine antibody testing. However, they can be useful in some situations where the antibody results are confusing, when there is need to clarify indeterminate tests results, when routine serology tests are likely to be misleading, as in patients with agammaglobulinemia, acute retroviral infection, neonatal HIV infection, and patients in the window period following a viral exposure. The sensitivity of the tests varies with the stage of disease and test techniques, but is usually reported at greater than 99 percent for DNA-PCR, and 90-95 percent for quantitative HIV-RNA. The DNA-PCR and RNA-PCR are not considered sufficiently accurate for diagnosis of HIV without a confirmatory test. The false-positive rate is too high.
Antibody testing is still more accurate, but because of situations such as those listed above (yours included), viral load testing is sometimes also necessary and can indeed be useful. Perhaps someday, the antibody test will be considered "outdated," but that day has not yet arrived. It's still the best we have. As for viral load testing in place of antibody testing, it's really not a question of spending a few more dollars, but rather a question of being able to diagnose the condition with the greatest accuracy.
In your case, a viral load test of 130,000 is impressive, but I would still recommend confirming that result, even though most false-negative viral load tests have low titers (less than 10,000).
I do appreciate your frustration and anger over this situation. However, the recommendations for testing remain the same. It's unfortunately the best we have at the moment. As for "men who readily bareback if someone says they are negative," they are being naive. Even if a hot stud offers to strap a lie detector on his Mr. Happy, no way would I believe that line!
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