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By Valendar Turner
Department of Emergency Medicine, Royal Perth
Hospital, Perth, Western Australia
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#Valendar Turner
#HIV Tests
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#ELISA
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#Viral Load
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What evidence authenticates a positive HIV antibody test as proof of HIV infection? This question has greatly interested me because those of us who work in Emergency Medicine spend a considerable part of our lives exposed to other people's blood and body fluids, a circumstance which, according to the experts, places us under constant threat of death from AIDS. Ironically, if the experts are right, the life we save may cost us our own and it's little wonder that some of us have pursued the question of proving HIV infection to the very limits. From the early days of AIDS I was fortunate to collaborate with Eleni Eleopulos, a Biophysicist at the Royal Perth Hospital, John Papadimitriou, Professor of Pathology at the University of Western Australia, and other colleagues, and in one of our papers, published in June 1993 in the journal Bio/Technology [1], we were compelled to confront many unsettling conclusions about the HIV antibody tests, none of which accord with current wisdom. Some of these I would like to share with you today.
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In the entire AIDS literature there is only one study, that of Colonel Donald Burke and his colleagues [3] from the Walter Reed Army Institute, which is widely regarded as the definitive proof of the specificity of the HIV Western blot. Over an eighteen month period Burke and his colleagues tested 1.2 million applicants for US military service. Burke's testing procedure was a progression through two ELISAs and two Western blots. From these data the HIV seroprevalence was found to be 1.48/1000. Burke then retrospectively investigated a highly selected sample of this population in which the seroprevalence was one tenth that of the 1.2 million. This group comprised 135,187 persons aged 17-18 years who resided in rural areas where the cumulative incidence of AIDS was low. Many would assume this group to be no different from healthy blood donors and regard all HIV positives as false positives but Burke and his colleagues' premises were the opposite. Assuming there were true positives amongst healthy, rural American youth and wishing to evaluate the false positive rate and specificity of the Western blot Burke needed to define HIV infection. This was done by performing a panel of four more antibody tests on sera from the 15 out of 135,187 applicants who had already been found twice ELISA and twice Western blot positive. Two of the extra tests were other Western blots and two were similar tests. Any individual positive in all four extra tests, thereby making a total of eight positive antibody tests, was deemed HIV infected. Those who failed any of the extra four tests were deemed non-HIV infected. Of the 15, one failed to complete the panel and thus Burke conceded only one, not fifteen, false-positives. From these data Burke calculated the specificity of the HIV Western blot to be in excess of 99.9%. There are many flaws in this study and they are outlined in reference 1. Here I wish to draw to your attention to the fact that an antibody test, even if repeated and found positive a thousand times, does not prove the presence of a viral infection.
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