Arguments on the Connect board - help us out! (COMMON TESTING MISTAKES, 2010)
I'm sure you don't waste your extremely limited spare time by surveying the fluffernutters on The Body's Connect "Am I Infected" forum. Whilst a valuable resource, it does seem to fuel the fears of many.
But I was hoping you could help with a situation that seems to be causing some debate.
After a questionable exposure (let's assume unprotected sex) to an allegedly Positive woman, a man came down with typical ARS symptoms, and has since had the following testing history & results:
4th month indeterminate elisa 7th month negative elisa 9th month POSITIVE quick test 10 month indeterminated WB (P31 banda) 11 month undetectable viral load CD4 511 14 month negative DNA proviral hiv 1 (roche 1.5) 14 month negative elisa 16 month negative elisa 18 month negative elisa CD4 312 CD4/CD8 0.54
What would your assessment be of the situation?
Any help appreciated as when information like this goes unquesitoned or unmoderated, it doesn't do anyone any good!
Thanks, Dr. Bob.
Sure thing. Glad to help.
Unprotected sex with Miss Positive would put Mr. X at risk for STDs, including HIV. Consequently STD testing including HIV testing would be warranted. This would be considered a significant HIV exposure and, therefore, HIV-antibody testing should be recommended at both the three- and six-month marks. Symptoms, typical or not, are notoriously unreliable in predicting who is and is not HIV infected.
Mr. X, like so many other feckless dudes who decide to go commando Rambo (no condoms), would up having way too many tests. Excessive testing increases the likelihood of getting a false-positive result and that's what happened to Mr. X's nine-month rapid test. It's a false positive test result (based on subsequent test results).
Also, way too commonly the wrong HIV diagnostic test is ordered either directly by a patient or by a careless, misinformed doctor. This would explain the indeterminate Western Blot (WB) test at 10 months. WB tests should never ever be run as stand-alone HIV-diagnostic tests! They are useful only as confirmatory tests performed immediately following a positive ELISA. (Running a stand-alone WB a full month after the positive rapid test without repeating the rapid test or getting an ELISA is inappropriate.) Stand-alone WB tests with a p31 band have essentially no diagnostic significance.
Next, another mistake is to run CD4 tests for no reason. They are not diagnostic tests, nor are they HIV-specific tests. A CD4 count should only be run after an HIV-positive diagnosis has been confirmed to ascertain the degree of immune damage. Consequently Mr. X's CD4 counts at months 11 and 18 were unwarranted and inappropriate.
Mr. X also had a qualitative HIV PCR DNA at month 14. This test is not FDA approved for diagnostic purposes. It, too, was ordered inappropriately.
In essence all of Mr. X's tests after six months (in his case seven months) were unnecessary and inappropriate. There was no indication for additional testing at months 9, 10, 11, 14, 16 and 18.
Had Mr. X merely followed well-established HIV-testing guidelines, he would never have gotten a false-positive result nor inappropriate WB, HIV PCR DNA, multiple CD4 counts and ELISAs.
HIV-diagnostic testing is not rocket science! It's very accurate, sensitive, specific and easily interpreted if you simply follow the guidelines.
Hope that clears things up.