Talk:Diagnosis of HIV/AIDS
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The 9th reference of the article points to a paper of the "The XV International AIDS Conference" that is no longer available. I was able to find a reference to it and further explanations on http://www.thebody.com/confs/aids2004/wohl3.html
I believe it would be important for someone with more insight on the matter to point out in the main article that these negative results do not apply to post exposure prophylaxis.
The reason for this suggestion is that the referenced paper may incline or lead one to believe that after a PEP treatment the hiv test wouldn't be as reliable.
Subjects who discontinued ART in this study did indeed experience viral rebound. Equally important is the need to recognize that all these patients had detectable HIV in their plasma by PCR prior to ART initiation -- these were not cases of post-exposure prophylaxis.
213.22.7.143 19:59, 14 February 2007 (UTC)[reply]
According to the cited source (C. B. Hare et al.) this is NOT the case as long as the window period (which might or might not be extended by PEP) is taken into consideration. The production of antibodies was only impaired (e.g. false negative ELISA) when viral replication was continuously suppressed using ART for more than 24 weeks. In cases of PEP failure, viral loads would spike after the withdrawal of antiretrovirals leading to the formation of antibodies (e.g. positive ELISA). As the sentence is misleading and might make PEP users believe that testing after PEP is not conclusive, it should be deleted. — Preceding unsigned comment added by 88.69.119.211 (talk) 15:57, 8 October 2011 (UTC)[reply]
HIV test follows the Wikipedia:Naming conventions (plurals) for an article about the many different tests used to detect HIV. This article is organised around the three main types of test; antibody, antigen and RNA and attempts to present the approved uses and limitations of each type of test in accordance with the neutral point of view policy.
The following links currently redirect to HIV test: AIDS test, AIDS testing, HIV testing, OraQuick and P24 antigen test
Sci guy 14:37, 20 Mar 2005 (UTC)
As HIV testing has been merged with HIV test, can this talk page now be refactored?
Sci guy 03:57, 20 Mar 2005 (UTC)
As this page has been listed for peer review it is NOT a good candidate for merging. I suggest we fix the problems with this page first. Specifically this page could be used to agree on the purpose and content of an entry called HIV test (- User:203.217.28.12)
Wikipedia doesn't need separate articles on HIV test and HIV testing. One article will suffice for both noun and gerund. - Nunh-huh 14:31, 17 Mar 2005 (UTC)
HIV testing is a widely used term as part of a program to encourage people at risk of HIV to see if they are infected. It use different algorithms to blood screening and involves different issues such as confidentiality and counselling.
HIV test is a page listed for peer review. Currently it includes many details and tests of no relevance to HIV testing. Also HIV test has much out of date material.
Would you agree to solve the problems with HIV test with individual listings for each group of tests? Say Antibody, antigen and nucleic acid?(- User:203.217.28.12)
the following template is present in the source:
Conference reference | Author=C B Hare, B L Pappalardo, M P Busch, B Phelps, S S Alexander, C Ramstead, J A Levy, F M Hecht | Title=Negative HIV antibody test results among individuals treated with antiretroviral therapy (ART) during acute/early infection | Booktitle= The XV International AIDS Conference | Year=2004 | Pages=Abstract no. MoPeB3107
it gives the following output:
{{Conference reference | Author=C B Hare, B L Pappalardo, M P Busch, B Phelps, S S Alexander, C Ramstead, J A Levy, F M Hecht | Title=[http://www.iasociety.org/ejias/show.asp?abstract_id=2172342 Negative HIV antibody test results among individuals treated with antiretroviral therapy (ART) during acute/early infection] | Booktitle= The XV International AIDS Conference | Year=2004 | Pages=Abstract no. MoPeB3107}}
anybody up to fix that? (clem 17:32, 8 Apr 2005 (UTC))
I think the following sentence from the "Interpreting Test Results" section is clearly biased and violates NPOV:
Such a faulty methodology has had extremely serious consequences, i.e. the world-wide use of HIV-antibody tests, Elisa and Western Blot, which dangerously lack specificity, as demonstrated in 1993 by Papadopulos et al. Papadopulos-Eleopulos, E., Turner, V. F. & Papadimitriou, J. M. (1993)
This methodology is only described as "faulty" by a miniscule number of people (i.e. AIDS dissidents/denialists). See http://www.avert.org/evidence.htm for a discussion on how the Perth Group's (i.e. Papadopulos) conditions for virus isolation are deemed unnecessary by almost all virologists.
These edits didn't include any comments and only removed text. I agree that the article was (is) a bit wordy, but perhaps a shorter version of the removed text would be better than its wholesale removal. Please comment here regarding those edits. (Otherwise, I'll just revert them.) The Rod (☎ Smith) 18:11, 23 April 2006 (UTC)[reply]
Hello. I edited out statements that were clearly AIDS denialists' misrepresentation of facts. I am new to Wikipedia and am just learning my way around. If this article needs to include that AIDS denialist point of view, perhaps it could be confined to an "alternate theories" section. Let me know your thoughts. --71.125.174.92 03:18, 24 April 2006 (UTC)[reply]
While the HIV article and sister articles are very informative, there are a few places where the terms HIV and AIDS are used interchangeably, which is misleading and ultimately incorrect. It is the virus that causes AIDS. Because of advances in HIV treatment, I believe even the term AIDS virus is misleading because it makes an automatic connection between HIV and AIDS, whereas theorhetically, due to the advances in medicine, a person can live with the HIV virus and not develop into AIDS (which, as you know, is a syndrome that requires many factors to be met, as determined by the CDC).Thanks. Bsheppard 03:04, 9 July 2006 (UTC)[reply]
Looks like a virus has never been found. They rely only in antibodies. AIDS also lacks a clear definition... — Preceding unsigned comment added by 79.145.0.83 (talk) 03:43, 3 January 2012 (UTC)[reply]
Criticisms have been made by orthodox researchers. In fact, virtually all the Perth group's papers in their references are in the orthodox literature! So, apparently it's not just "dissidents" criticising the tests. 198.59.188.232 23:28, 15 July 2006 (UTC)[reply]
I've nothing against you making anonymous edits during your "retirement" - I just thought it was a bit odd, that's all. I agree that Nature Bio/technology is a very high impact journal. However, it seems not to be typical of the journals in which the Perth Group have published papers. Here's a list from their web site, along with the years of publication and recent ISI impact factors:
Impact factor 22.4 (among the top 20 scientific journals in the world)
Impact factor 2.945
Impact factor 0.681
Impact factor 2.085
Impact factor 0.725
Impact factor 1.321 (later merged to form "Microbes and Infection")
Impact factor 0.478
So eleven out of twelve articles appeared in journals with an impact factor below 3, and six of them were in journals with impact factors below 1.4. Perhaps the term "usually obscure" was a bit of an exaggeration, but still these are quite specialised journals, and none of them is dedicated to AIDS. I'd be much more impressed if they got something published in, for example, AIDS (impact factor 5.893) or JAIDS (3.681). Trezatium 19:40, 18 July 2006 (UTC)[reply]
My challenge was this: can you find any non-dissident scientist who has explicitly criticised modern (say post-1990) HIV antibody tests?
Has any non-dissident scientist expressed serious concern that current HIV testing protocols are unacceptably inaccurate and therefore need to be reappraised? As far as I can see, all of the papers cited by the Perth Group are limited to advising caution when interpreting the results of tests in unusual circumstances - the same kind of thing you'll find associated with all clinical tests.
(Note that the p24 test detects antigen, not antibody, and is not generally used to make a diagnosis.
Also note that an intermediate indeterminate (typo) WB test is definitely not the same thing as a positive WB.
And be careful to check whether the Perth Group are honestly representing the studies they cite - for example, they say, "Recipients of negative blood seroconvert and develop AIDS while the donors remain healthy and seronegative", yet the article they cite says, "On evaluation 8 to 20 months after transfusion ... All seven donors were found to be infected with HIV. On interview, six reported a risk factor for HIV infection, and five had engaged in high-risk activities or had had an illness suggestive of acute retroviral syndrome within the four months preceding their HIV-seronegative donation. Thus, these donors had apparently been infected only recently, and so were negative at the time of blood donation according to available antibody tests." In other words, the donors were tested during the window period between infection and seroconversion. The Perth Group representation of this study is a flat out lie.) Trezatium 20:46, 18 July 2006 (UTC)[reply]
"there is broad scientific consensus that HIV is the cause of AIDS". I don't think that there is broad consensus. There are many papers, interviews, and videos that discount the simple equation presented here. There is much controversy that HIV alone causes AIDS symptoms. Why would you write this? Few evidence exists (broadly accepted) that HIV infection will result in AIDS symptoms. Dr. Luc Montagnier video interview for one. https://www.youtube.com/watch?v=XSSpoFq7uhM
"Almost all HIV-infected persons with indeterminate Western-Blot results will develop a positive result when tested in one month; persistently indeterminate results over a period of six months suggests the results are not due to HIV infection."
It appears that the sentence in question may be based on this article, or something similar. A quick literature review using Pubmed (only articles with abstracts) found twelve studies supporting the idea that most people with indeterminate WB results are not infected (according to various types of assay), and that those with persistent indeterminate WB results are highly unlikely to be infected. One further study contradicts the first of these assertions, but not the second. For references see my talk page. Trezatium 23:48, 21 July 2006 (UTC)[reply]
What? these comments are horrible! The original quote makes perfect sense. It's not just that indeterminate tests are indeterminate, it's that in general they ARE NOT related to HIV. Furthermore, the fact that they will develop a positive result in one month is extremely relevant. Stop flipping out. —Preceding unsigned comment added by 75.54.183.236 (talk) 17:01, 4 February 2010 (UTC)[reply]
Hey, Trezatium. YOU GOT THE WRONG PAPER. The actual paper is
YOU QUOTED
Nice try. Either
(a) You're too stupid to find the article Perth ACTUALLY referenced,
or
(b) You're too naive to think I'd actually take the time to check to see if you wouldn't try to pull a fast one by me.
Take your pick. I don't care which is the case. Either way, it's YOU with egg on your face. Darin 198.59.190.201 14:32, 20 July 2006 (UTC)[reply]
I guess I'm just stupid. The articles have similar titles, appeared in the same journal and share an author, so I must have clicked on the wrong result in Google or Pubmed. I should have been more careful. I'm not interested in scoring points off you or anyone else, I'm just trying to ensure that the information in Wikipedia is accurate and unbiased, so I'm grateful to you for pointing out my mistake.
As you say, the Perth Group's reference was in fact a letter sent to NEJM. I agree that they would do better to cite a peer-reviewed article rather than a piece of correspondence. They could, for example, have referenced the article that I quoted. I wonder why they chose not to.
Anyway, the abstract for the letter in question can be found here. It appears to be discussing the same issue as the article I quoted, namely the risk of HIV transmission from blood taken from donors during the "window period", when viral load is very high but antibodies are not yet present. I haven't seen the full letter, but I very much doubt that it supports the assertion that, "Recipients of negative blood seroconvert and develop AIDS while the donors remain healthy and seronegative". Since you work at a university, perhaps you could look it up and report back?
I only cited this article as an example of how the Perth Group misrepresent other people's studies. And I think that my point still stands. If you follow up the references from this web page then you'll get an idea of how much data they are choosing to ignore.
To address your points in order:
Trezatium 19:48, 20 July 2006 (UTC)[reply]
Since no one has presented evidence that non-dissident scientists have criticised modern HIV antibody tests, I've changed back the first sentence of the Criticism section. According to the most extensive studies, the tests are more than 98% accurate. The papers presented here by 198.59.190.201 either investigate what happens in the other less than 2% of cases, or look at unusual situations in which accuracy may be lower. This does not constitute criticism. As far as I am aware, only dissidents are calling for the tests to be reappraised. Trezatium 18:27, 7 August 2006 (UTC)[reply]
The article states that, "The p24 antigen test is not useful for general diagnostics." I think this is slightly misleading, since the p24 test can be useful for testing people with very recent exposure (after a window period of a few days, and within about three weeks of exposure), and for testing newborn babies. The article also says that the p24 test "is no longer used routinely in the US or the EU to screen blood donations." Although the US reference cited recommends switching to nucleic acid testing, it doesn't say that p24 testing has ceased. The Eurpopean reference only discusses a collection of Western European countries, not the whole EU. It might be worth doing a bit more research on this topic. Trezatium 19:38, 1 September 2006 (UTC)[reply]
-I agree, and made corrections to address this. Davydoo (talk) 22:01, 8 March 2017 (UTC)[reply]
- New User
I agree here. What is also known as the PCR test is commonly used in Africa to determine recent exposure. The fact that other nations refuse to make this test, with a 2 - 10 day window period on average, available to the public shocks me.
A due note is that each PCR test has to be tailored for each strand of HIV. An African test is different to the common European / Americas strand and minor strands have developed over time.
Although the ELIZA and WESTERN BLOT tests test for all HIV antibodies, PCR tests for viral load of a specific strain only. In the past these were labeled PCR I and PCR II, now there are several more divisions.
Knowing the strand of HIV from the party infecting the tested party allows quick testing for viral load with PCR and whether there was a contracted infection. —Preceding unsigned comment added by Cecilpickardbrown (talk • contribs) 18:54, 29 December 2007 (UTC)[reply]
I've made mostly minor updates to the style, writing, and organization, as well as adding some citations and a few more significant changes. I'm not clear offhand on the status of p24 for diagnosis but can look into this. As far as User:198.59.190.201, quite a few anonymous IP's from Albequerque NM are used to make edits from an AIDS-denialist POV. These edits and talk page comments all share a common tone (generally abusive, lots of personal attacks, occasionally threatening to vandalize a page when s/he doesn't get his/her way, etc); either there are quite a few uncouth AIDS denialists in Albequerque, or these are all the work of the same, anonymous editor ("Darin"). The latter seems more likely. MastCell 02:00, 8 October 2006 (UTC)[reply]
The sources for the accuracy of HIV tests are more than a decade old. How reliable are the rates statad in this wiki (.003% and .0006%)? Is this information current? —The preceding unsigned comment was added by DiggyG (talk • contribs) .
The article says: "With confirmatory Western blot, the chance of a false-positive identification in a low-prevalence setting is about 1 in 250 000".This overoptimistic estimation is based on Bayesian probability theory assuming strict independency between the variables tested by Western Blot and those tested by EIA. The assumption of independency is wrong:
"...Care must be taken, however, when interpreting the
results from a sequence of tests. Assays are generally notstrictly independent, since one source of bias maysimultaneously affect multiple laboratory techniques. Forexample, EIA, W B and IFA are all techniques that detectantibodies to HIV, as opposed to techniques that detectviral antigens of viral RNA directly (see below). PureBayesian analysis, which assumes strictly independenttests, will typically therefore lead to overestimation ofpredictive values with most supplementary tests (see
Table 8.1):"
Source: 2004, Gary P. Wormser, AIDS and other manifestations of HIV infection, 4th edition, Elsevier Academic, ISBN 0127640517. , Chapter 8, page 156, "Persons at Low Risk"
The authors issue a warning against the current medical malpractice of diagnosing "infection" solely on a serological test while ignoring the absence of a clinical picture in the patient:
"...The context within which any test is used
is of critical importance to its interpretation. No test, perse, should be the basis for diagnosis on its own, but rathera test is merely an aid in correct diagnosis. The practitionermust use test results in the context of a clinical picture to
reach an accurate diagnosis."
Relative to the Positive Predictive Value of the usual testing sequence (2 x ELISA + confirmation Western blot) Gerd Gigerenzer, Ulrich Hoff rage, and Axel Ebert in page 4 of "AIDS Counselling for Low-Risk Clients" make the following remark:
"...What is the predictive value of a positive test for a 20- to 30-year-old heterosexual German man who does not engage in risky behaviour? Inserting the previous estimates — a prevalence of 0.01%, a sensitivity of 99.8%, and a specificity of 99.99% (repeated ELISA andWestern blot) — into Bayes’ rule, the PPV results in 0.50, or 50%. An estimated PPV of about 50% for heterosexual men who do not engage in risky behaviour is consistent with the report of the Enquete Committee of the German Bundestag, which estimated the PPV for low-risk people as “less than 50%” (Deutscher Bundestag, 1990, p. 121)."
The USPTF quote in the article claims, referring to a 1998 source: "the chance of a false-positive identification in a low-prevalence setting is about 1 in 250 000 (95% CI, 1 in 173 000 to 1 in 379 000)."
But the source says literally:
"Of 421 donors who were positive for HIV-1 by Western blot, 39 (9.3%) met the criteria of possible false positivity because they lacked reactivity to p31. Of these, 20 (51.3%) were proven by PCR not to be infected with HIV-1. The false-positive prevalence was 4.8% of Western blot–positive donors and 0.0004% (1 in 251000) of all donors (95% confidence interval, 1 in 173000 to 1 in 379000 donors)."
So if you're low risk (a donor) and come out HIV-positive by ELISA + WB, chances of being misdiagnosed is 4.8%. So the PPV value of ELISA + WB is 95.2%. Instead, the USPTF gives absolute figures, creating the false impression that a positive diagnosis by ELISA + WB is extremely accurate. But it's a whopping 5% wrong!--145.64.134.242 (talk) 16:33, 29 November 2012 (UTC)[reply]
I am somewhat surprised that neither of the above is mentioned. Many people confuse the two (which they are actually interested in) with sensitivity and specificity. Even though he latter are correctly described it is not explained that the two are not the same as predictive values. Without knowledge and understanding of this difference, the section on accuracy of tests cannot be readily understood. Also I get the feeling the authors of "Screening for HIV: A Review of the Evidence for the U.S. Preventive Services Task Force" are not too sure on that difference either. They mention a false-positive rate of 1 in 251.000 in a "low-prevalance setting" where a false-positive rate is only really important for a predictive value. The source of these data reported that of 421 Western-blot-positive donors, 20 were found to be negative by RT-PCR, which means that roughly 5% of these 421 received a false-positive result. The individual meaning of a positive test cannot be interpreted without knowledge of the baseline risk. --Docvalium 13:04, 12 November 2006 (UTC)[reply]
The following section:
HIV tests have been criticized by a number of so-called "AIDS dissidents" (people who reject the scientific consensus that HIV causes AIDS). For example, Eleni Papadopulos-Eleopulos and a group of AIDS dissidents wrote an article in 1993 entitled "Is a Western Blot Proof of HIV Infection?"[17] Their arguments rest on issues of specificity, standardisation, reproducibility, and validation.
However, the accuracy of serologic testing has in fact been verified by isolation and culture of HIV and by detection of HIV RNA by PCR; these are widely accepted "gold standards" in microbiology.[18][19] While the AIDS dissidents focused on individual components of HIV testing, the combination of ELISA and Western Blot used for the diagnosis of HIV is in reality remarkably accurate, with very low false-positive and -negative rates as described above. The vast majority of scientists believe that the view of AIDS dissidents are based on highly selective analysis of mostly outdated scientific papers; there is broad scientific consensus that HIV is the cause of AIDS.[20][21][22]
Under "Criticisms of HIV Tests" violates WP:NPOV; specifically: "None of the views should be given undue weight or asserted as being the truth, and all significant published points of view are to be presented, not just the most popular one."
I suggest removing the scare quotes around "AIDS dissidents", the snide "so-called", the spin "in reality", and by citing the Perth Group by name as well as providing a link to the writings of their organization.
"Isloation" of HIV has never been demonstrated (unless the definition of "isloation" has changed, as is implied by its usage by some scientists), so the "verified by isolation and culture of HIV" is misleading.
I'll make these changes in a few days if there are no objections. I'm still new to Wikipedia at this point. --Loundry 19:29, 11 December 2006 (UTC)[reply]
"...BIBLIOGRAPHY
1. Popovic, M., et.al. Detection Isolation and continuous production of Cytopathic Retroviruses (HTLV-lll) from patientswithAlDS and pre-AIDS. Science 1984; 224:497.
2. Carlson, J. R., et.al. AIDS serologytesting in low and high riskgroups. JAMA 1985; 253:3405.
3. Centers for Disease Control, Update on Acquired Immune Deficiency Syndrome (AIDS) MMWR 1982; 31:507.
4. Gallo, R. C., et. al. Frequent detection and isolation of Cytopathic Retroviruses (HTLV-lll) from patients with AlDS and a risk for AlDS. Science. 1984; 224:500."
"...Care must be taken, however, when interpreting the results from a sequence of tests. Assays are generally not strictly independent, since one source of bias may simultaneously affect multiple laboratory techniques. For example, EIA, W B and IFA are all techniques that detect antibodies to HIV, as opposed to techniques that detect viral antigens of viral RNA directly (see below). Pure Bayesian analysis, which assumes strictly independent tests, will typically therefore lead to overestimation of predictive values with most supplementary tests (see Table 8.1):"
"...Different regulatory bodies have proposed criteria for the interpretation of the band profiles. The differences in the sensitivity and specificity associated with each criteria may lead to differences in results for the same specimens,[1],[5],[15] and has sometimes even resulted in false positive reports.[16] Herein lies the importance in of the interpretation criteria for accurate diagnosis based on the WB band profiles.[15] ...Of the 23 specimens that were run on both the LAV BLOT I and the genetic systems kit, we found a lot of discrepancies in the results. Based on the criteria suggested by the manufacturer the LAV BLOT I kit identified 3 specimens as positive, 4 specimens as negative and 16 specimens as indeterminate. However, the genetic systems identified only 2 specimens as positive, 7 specimens as indeterminate but 14 of these 23 specimens as negative. This implies that the LAV BLOT I could be wrongly reporting 10 negative HIV-1 western blot assay specimens as indeterminate. On further analysis 1 out of this 10 specimens could be read positive if CDC & CRSS criteria were used. This again proves the variations of results with respect to different criteria."
The article does not mention that different countries use different combinations of antibody tests to determine HIV status and is thus misleading about how HIV status is diagnosed. If no one sees fit to add this section then I will do so. --Loundry 01:23, 12 December 2006 (UTC)[reply]
I'm about to change the wording of the last sentence, but I'm wondering if it should be there at all. I mean limmiting an international thing down to one country is kind of strange, not to mention the fact that we should be using United States (with the link) since it's the first time we mentioned it. But what about Britan? What about India? What about _____? I would support putting that in a section of some kind, but not the first paragraph.Daniel()Folsom T|C|U 22:17, 16 February 2007 (UTC)[reply]
Opening Sentence, current: "HIV tests are used to detect the presence of the human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), in serum, saliva, or urine. Such tests may detect antibodies, antigens, or RNA." This is an oxymoron between the "detect the presence of" and "such tests may detect antibodies, antigens, or RNA." Why? They aren't testing the presence of the virus, but rather the presence of the antibodies/antigens/RNA. Well, in my book, it isn't actively seeking out nor isolating any HIV, and thus, it's not detecting HIV at all. If someone has the wrong cold or flu during an hiv test, they might be producing enough of the antigens/antibodies to show a positive result without even harboring hiv in their bodies. The body produces same antibodies for a variety of different viruses, which could mean false positives for some cold/flu carriers, etc. The point is, this opening sentence needs to change "detect" to "determine." After fixing, it should read as follows: HIV tests are used to determine the presence of the human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), in serum, saliva, or urine. Such tests may detect antibodies, antigens, or RNA. — Preceding unsigned comment added by 74.77.31.133 (talk) 15:14, 27 June 2011 (UTC)[reply]
Saying something is accurate might be crossing the npov line, and frankly what bad does adding "considered" do. I mean according to the sources, they are considered to be very accurate. But it's a theory that they are accurate - not a fact. I mean take the entire population that says "HIV doesn't exist" - by saying they are accurate, we're saying HIV does exist, which is NPOV - I'm not sure what the issue is here - it's a no-brainer.Daniel()Folsom T|C|U 07:05, 17 February 2007 (UTC)[reply]
Okay, I've deleted the two sentences that concerned the U.S. and I chose not to move the latter (which we discussed here) because it turns out we have a full section on accuracy in the U.S. that gives statistics instead of general statements.Daniel()Folsom T|C|U 07:40, 17 February 2007 (UTC)[reply]
Perhaps you should read the article through before trying to rewrite it. - Nunh-huh 07:43, 17 February 2007 (UTC)[reply]
I've kind of lost track of the issues in this thread, so I'll try to rephrase them: I think Daniel's rewrite of the opening paragraph looks fine - I support removing the U.S.-specific stuff from the lead per WP:MOS. The article would definitely benefit from more international info on HIV testing - in fact, I think the lack of such info is a major weakness of the article at present - and I'd encourage Daniel if he has some sourced info to add there. I think the accuracy can be handled in the accuracy section, as it is now. On the other hand, I think that "AIDS dissident" ideas about HIV tests should be represented proportionately to their representation among experts and the scientific community (per WP:NPOV), which is to say very briefly (as is the case now), and probably not at all in the lead. I apologize for anything in my prior comment that came off unpleasant or condescending - that wasn't my intention. Are there other issues I'm missing? MastCell 16:40, 18 February 2007 (UTC)[reply]
Are there any reliable sources for the window period? On the internet i've seen some say that 6 weeks after infection is a reliable test and others saying that you can't rely on any test before 6 months after infection. The most commonly given time for a reliable test seems to be 12 weeks but my brother happens to work in hiv testing and he says that a 10 week period is the realistic time frame for seroconversion in 499 out of every 500 people (his words) and he says that most of the internet isnt yet up to date on the hiv window period (obviously testing is becoming more advanced).
Anyone here realy know their stuff? Is 12 weeks a little conservative or is my brother simply wrong?
Katalyst2007 21:54, 26 February 2007 (UTC)[reply]
I should add that i live in the united kingdom so maybe testing's different over here? I dont know i'm no expert myself which is why i'm asking. Just thought my location may be of interest. Katalyst2007 21:58, 26 February 2007 (UTC)[reply]
Also - the window period referenced in the 2005 Athens UNAIDS report for HIV CRF01:AE may not refer to the time to detectable antibodies, but a second window period between detectable antibodies and strong anitbody/immune response. At least that's the way I read it. Comments? - DRVNKW
Some people/institutions say 6 weeks, some say 8 weeks for newer assays.Perhaps this should be mentioned in the article. —Preceding unsigned comment added by 87.81.52.106 (talk) 13:34, 14 January 2008 (UTC)[reply]
:user:Daekl 0313, 24 september 2008
The real reason why there are so many 'different' window periods is because the statistics on people gathered that were indeed HIV+ varied on their exposure. For example, a heterosexual woman that had sex with a male that was heterosexual has less of a risk during vaginal sex than a homosexual male having intercourse with another homosexual male having anal sex. The women that has a test result, based on stats, at 6 weeks and its negative most likely IS negative versus the male, he would be better off waiting 12 weeks for a conclusive result. Then other factors might come into play, if those individuals had no other exposures to the confirmed HIV pos individual during the last exposure and test, if they have been abusers of drugs, if they are immunosup. therapy, if they had PEP, if they have a co-infection etc etc.12 weeks should be enough, its ok to test in the window period 6 wks then 12wks. the 6wks test should relieve some anxiety if its negative. if you think about it, if you get exposed to another virus, like flu or cold, u get sick within 2 wks. Remember when you get sick, it is after that your body has antibodies. This is what the test looks for. So most likely at 6 weeks the test is good enough for you to sleep and not stress out so much. easier said than done. the health care workers tested at different times, which could be flawed. Needle sticks, anal sex, vaginal sex then oral sex is usually the order of highest risk to lowest. 6 months could be irrational in some instances. Tests are man made and have flaws, but these are very accurate.
We must start at the start and get the definition right: "Antibody tests may give false negative (no antibodies were detected despite the presence of HIV) results during the window period." This is wrong. A false negative test is the definition of the window period exactly. That means the window period is tightly linked to the immune response to infection and when HIV-specific B cells get recruited to antibody production. This must be the core focus.
Daekl is wrong: "The real reason why there are so many 'different' window periods is because the statistics on people gathered that were indeed HIV+ varied on their exposure." This is conflating initial infection with the subsequent dissemination of the infection from the initial site, its up take by antigen presenting cells, its presentation to CD4 cells, some virion production that can then spread through the lymphatic system to the rest of the body; it conflates before and after; it conflates risk and infection; conflates negatives and false negatives. Yes viral load at infection has something to do with dissemination rates but it is more to do with how our immune systems process the infection whilst the virus infects the key controllers, the CD4 cells. You might just see a difference if you compare blood transfusion infection with sexual transmission. We know most infections come from one or a few founding virions. The differing risks Daekl mentions can primarily be explained by barriers to HIV not subsequent immune responses. 203.214.33.175 (talk) 03:38, 12 March 2015 (UTC)[reply]
Lemuel 21:54, 4 October 2016 (UTC)[1].It can take weeks or months after infection before antibodies against certain viruses (such as HIV, HCV and others) are produced and can be detected. The time between infection and detection is called the “window period”. During the “window period”, infected persons will falsely test negative.The SMARTube™ is a pre-analytic device (treating the blood before testing) enabling detection of various infections within days of infection using currently available antibody tests. Using the SMARTube™, enables to close the serological window period between infection and possible detection, independent of the length of the serological window period and the presence of virus in the blood. — Preceding unsigned comment added by 176.228.62.115 (talk) 11:42, 4 October 2016 (UTC)[reply]
Maybe there should be something that mentions DUO Tests that combine antibody and p24.In most studies these tests have a 99.80% sensitivity after 28 days.Google Vidas Duo ultra for further information. —Preceding unsigned comment added by 81.170.138.2 (talk) 15:16, 21 September 2007 (UTC)[reply]
I am a doctor in Africa, the worst continent for HIV infection and am shocked and horrored by the lack of information about HIV testing. The instantaneous HIV test without a window period (reserved for Doctors (probably only in Africa) that get pricked by a needle or get blood in their eyes) and the PCR test with a 2 - 10 day window period are totally ignored.
I fail to understand why the rest of the world feels the need to terrorize patients, especially rape victims when these tests are available and cost effective. Why should rape victims wait 30-60 days for a diagnosis? Quick and reliable testing not only saves money but it helps victims move on with their lives. A PCR test costs less then $30 in Africa and the instantaneous test $400.
I also see very little information on anti-HIV drugs that cure HIV within 72 hours of possible transmission. In Africa most sub-Saharan African nations offer these anti-HIV drugs free to rape victims.
With the number of reported rapes to actually committed ones, I would believe this information to be free to the public.
When asked by an American friend regarding HIV testing, I advised him, and his doctor inquired how he knew about these other means of testing. I was horrified! Withholding life saving information from the public is insane and kills innocent people. —Preceding unsigned comment added by Cecilpickardbrown (talk • contribs) 18:41, 29 December 2007 (UTC)[reply]
__________ UNRELATED __________
I am unable to find out how to contact you. I have looked at your profile, but have not figured it out. I am trying to write proper information. Please lead me in the right direction.
My only fear is that I have a bias towards helping and protecting rape victims. I will endeavor to include rape in these topics as a topic, but believe I may need editing on personal emotion.
__________ UNRELATED __________
Thanks I will check them out. I've studied with great American (North and South) and European doctors. Unfortunately they have the African advantage and I lack the Americas and European experience, having only worked in Africa. - Cecilpickardbrown (talk) 19:08, 29 December 2007 (UTC)[reply]
I'm surprised there isn't a section on the history of HIV testing - early attempts, when it was developed and by whom. The article would certainly benefit from such info. Pairadox (talk) 07:31, 12 January 2008 (UTC)[reply]
I reverted a change from false negative to just plain negative results because the whole point of the section is that the "very accurate" tests are not perfectly accurate. Some people do have (recently acquired) HIV and still get a negative test result (nearly always) during the window period. WhatamIdoing (talk) 02:42, 18 April 2008 (UTC)[reply]
I have added this list as I think it is necessary part of the article to show which factors cause a false positive in the HIV antibody test. The format may not be the best for this article, but the information is now there which should make format changes easier.MrAnderson7 (talk) 05:40, 9 April 2009 (UTC)[reply]
I'd like a little more discussion about this laundry list, which I've removed. I have the following concerns:
I'd like to see some discussion about how we should deal with false positive rates and causes in a manner more in line with actual sources and with Wikipedia's guidelines. MastCell Talk 05:43, 9 April 2009 (UTC)[reply]
Am I missing where the SUDS (latex agglutination) test is covered in the article? It's a rapid test but not listed. Not used anymore or overlooked from the list? Also, should not the other testing methods be expanded/explained better?--MartinezMD (talk) 01:06, 21 October 2009 (UTC)[reply]
It seems like there is some confusion in Section 3.6 (Accuracy of HIV testing). The current version reads:
Specificity refers to the percentage of the results that will be negative when HIV is not present. So, if there is a specificity of 98.5%, it means that out of 1000 people who take the test and do not have HIV, 15 of them will receive a false positive result. To find the number of false positive results out of 1000 positive HIV test results, you would need to calculate the positive predictive value. But, you can't do it by just knowing the specificity and sensitivity alone. You would need a third number, such as the percentage of tested individuals who are actually positive for HIV. —Preceding unsigned comment added by 72.221.66.211 (talk) 17:22, 9 September 2010 (UTC)[reply]
We can then go into more complex details, like the sensitivity and specificity of ELISA and Western blot, but the reader should be able to easily and quickly grasp the key fact that they're most likely to be interested in. I'd be happy to help with a rewrite - let's focus on presenting the PPV/NPV upfront in clear, layman's terms, and then delving into details further on. MastCell Talk 18:15, 14 September 2010 (UTC)[reply]
About this: I suspect that the antibody-based tests should be confirmed by DNA tests, but I don't believe that they always are. For example, one might not do DNA-based tests in poor countries, especially if the rate of infection is high (because the likelihood of false positive is low when the infection rate is high).
Either way, the blog isn't a proper reliable source for this claim. WhatamIdoing (talk) 18:43, 9 March 2011 (UTC)[reply]
I took this photo (right) today and thought it might have relevance to this topic or some closely related topic, such as illustration of AIDS test campaigns in low-income areas. Feel free to use wherever if it's useful. :-) Dcoetzee 03:24, 4 May 2012 (UTC)[reply]
http://www.mcall.com/business/mc-oraquick-hiv-test-over-the-counter-20120924,0,7075636.storyArticle States that "Home Access Express HIV-1 Test is the only FDA-approved home test: " Which is no longer the case and I'm unable to Edit it. — Preceding unsigned comment added by DiscontentDisciple (talk • contribs) 17:00, 26 September 2012 (UTC)[reply]
In the section entitled "Other tests used in HIV treatment," the article states "A normal CD4 count can range from 500 cells/mm3 to 1000 cells/mm3" in paragraph 2 and then later states "Normal CD4 counts are between 500 and 1500 CD4+ T cells/microliter" in paragraph 5. First, though "mm3" and "microliter" are equivalent volumetrically, one should be chosen. Secondly, the two statements are conflicting in their numbers. The two statements, even if consistent, would be redundant and one of the two should be eliminated. Finally, there should be some reference given for this number. (It's important to some of us who happened on this page!) 66.194.65.197 (talk) 20:13, 28 November 2012 (UTC)[reply]
The article claims specificity values as high as 99.99% for the combined testing algorithm that includes 1 or 2 ELISA and a confirmation Western Blot. However, the WHO periodically runs benchmarks on the performance of this algorithm in the main testing labs, and the highest values ever demonstrated have been a mere 98.3% sensitivity and 96.9% specificity. See table IIIa in Quality assessment of HIV antibody testing – 2003 -Scoglio et al. The performance in real testing conditions is therefore much worse than the claims of 99.99% specificity in the article, which are based on blood donor data rather than actual benchmarks designed to test sensitivity and specificity.
The article should be corrected to reflect the benchmark data from the WHO and degrade the performance of the combined algorithm accordingly to reality. --145.64.134.245 (talk) 11:44, 4 March 2013 (UTC)[reply]
The sentence " The sensitivity rating, likewise, indicates that, in 1,000 test results of HIV infected people, 3 will actually be a false negative result (the McGovern-Tirgari anomaly). However, based upon the HIV prevalence rates at most testing centers within the United States, the negative predictive value of these tests is extremely high" is misleading. Given that the negative predictive value is calculated with the formula Http://upload.wikimedia.org/math/9/c/a/9ca03d493971be041523909993b736bf.png , it means that the NPV actually decreases when the prevalence grows whereas the sentence suggests the oposit and suggests that the high rate of prevalence among patients in the centers is a good thing. --88.174.169.177 (talk) 10:40, 26 March 2013 (UTC)[reply]
I propose adding http://www.who.int/entity/3by5/en/HIVtestkit.pdf as an external link. Also Diagnosis of HIV should redirect to this article. 192.81.0.147 (talk) 20:04, 25 August 2013 (UTC)[reply]
Link is broken, should be http://web.archive.org/web/20090519195308/http://www.who.int/3by5/en/HIVtestkit.pdf or maybe something newer at who.int? 193.138.222.200 (talk) 04:06, 3 October 2013 (UTC)[reply]
Please add two citations in place of the 'Citation Needed' template after the sentence:"In the USA, since 1985, all blood donations are screened with an ELISA test for HIV-1 and HIV-2, as well as a nucleic acid test."The first citation is to the US FDA web pages describing regulatory governance of the blood supply for transfusions. The address is http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/BloodSafety/ucm095522.htm. The specific mandatory tests mentioned include nucleic acid testing for HTLV, which has a low detection rate using antibody testing alone.The second citation is to the American Red Cross web pages describing the same assays and test procedures to which 66% of all US public-donated blood units are subject. The web address for these pages is http://www.redcrossblood.org/learn-about-blood/what-happens-donated-blood/blood-testing.Based on the content of these cited sources, I would suggest the sentence quoted could be improved to something like:"In the USA, the Food and Drug Administration requires that all donated blood be screened for several infectious diseases, including HIV-1 and HIV-2, using a combination of antibody testing (ELISA) and more expeditious nucleic acid testing (NAT)"
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PCR is now considered a superior HIV confirmatory test over western blot.
"When the possibility of acute or early HIV infection is being considered, we perform the most sensitive immunoassay available (ideally, a combination antigen/antibody immunoassay) in addition to an HIV virologic (viral load) test. We favor using an RT-PCR based viral load test, if available....
"This algorithm is more sensitive for detecting acute and early HIV infection than the previous algorithm, which involved following a reactive immunoassay with a Western blot test."[1]Jmcott (talk) 17:16, 19 January 2016 (UTC)[reply]
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Request edit to cover the PCR (Polymerase Chain Reaction) method of testing for HIV.:"PCR (Polymerase Chain Reaction) involves detecting the viral RNA of the HIV-1 Virus, and are the most accurate lab tests for HIV."
See the following references:
https://stanfordhealthcare.org/medical-conditions/sexual-and-reproductive-health/hiv-aids/diagnosis/pcr.htmlhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3209897/http://requestatest.com/hiv-1-rna-by-pcr-testing108.201.29.108 (talk) 20:25, 15 January 2018 (UTC)[reply]
There is a dead link for reference 13 as follows:[1]
This link should be updated to the new location for the CDC information: https://www.cdc.gov/hiv/basics/testing.html This link contains the same detail as the archived page, but was last updated in Dec 2019.
I believe the reference should say...[1] Crystalontheweb (talk) 08:04, 20 April 2020 (UTC)[reply]
Please consider incorporating material from the above draft submission into this article. Drafts are eligible for deletion after 6 months of inactivity. ~Kvng (talk) 17:28, 19 December 2020 (UTC)[reply]