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do you have the guts to comment on this?
Dec 27, 2009

Said by a top hiv prevention expert... "Although it is often said that immunosuppressive drugs might alter the reliability of HIV testing or delay seroconversion, this is purely theoretical. If it is real, it probably applies only to the most potent chemotherapy or profoundly immunosuppressive therapy, of the kind used for cancer chemotherapy or the giant doses of drugs used for acute life threatening immunologic diseases. Even these circumstances have never actually been reported in the scientific literature as having any effect. The garden variety sort of immunosuppression used to treat things like rheumatoid arthritis, lupus, psoriasis, or inflammatory bowel disease -- drugs like corticosteroids, methotrexate, and the biologic cytokine inhibitors have no known effect on HIV test results" ... merry christmas dr. Bob. Luciano

Response from Dr. Frascino

Hello Luciano,

Responding appropriately to a question doesn't really take "guts," but rather a scientific knowledge of the subject at hand. I have no idea of which "top HIV prevention expert" you are quoting or whether the quote is accurate. Chances are if the author of the quote is a well-trained and experienced HIV physician specialist, and he and I were allowed to discuss this rather complex topic, you would find we are most likely in agreement. The ability of immunosuppressive drugs to alter many aspects of the body's complex immune response and regulatory system, including the production of specific antibody production, is well documented in the medical literature. Demonstrating that a specific immunosuppressive drug at a specific dose for a specific disease within a specific patient affects the production of anti-HIV antibodies to a level sufficient to alter the result of a specific HIV-antibody test that relies on detectable levels of a specific antibody in the blood is obviously extremely difficult to document, due to the number of confounding variables. Is it possible? Yes. Even your guy states it's "theoretical." I believe it's more than theoretical; however, it's very difficult to "document". Missing a diagnosis of HIV disease can have catastrophic consequences. We have accurate methods of detecting HIV disease that do not involve detection of anti-HIV antibodies. While the anti-HIV antibody test remains the gold standard for a variety of reasons, the judicious use of the other tests is warranted in situations where even a "theoretical" complicating factor is in play.

Luciano, I hope you can see this has nothing to do with guts, but rather with basic scientific knowledge, experience, and common sense.

Dr. Bob



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