Dear Editor,
I strongly believe that it is incumbent upon me to reveal a suicidally depressing situation in which my brother was embroiled. Although incurable, I am cognizant that HIV/AIDS is no longer a death sentence and that it is justifiably categorized as a chronic illness like so many other potentially life threatening diseases. However, it is an incontrovertible fact that anyone who does an HIV test is always breathless in anticipation over the impending result.
Hence, my brother was no exception. During the month of August 2005, my brother was scheduled to depart Guyana to occupy a post for which he had applied and was successful. However, prior to his departure, certain tests were requested by his potential employer, as I am certain would be the situation for innumerable other countries. He subsequently proceeded unreservedly to acquire these at a private hospital located in Georgetown. Nevertheless, after the blood sample was collected and tests done, of the litany of tests, only the HIV test proved unfavourable. So, understandably he became crestfallen and felt as though the pursuit of his dreams was quickly receding to a state of nothingness.
The following day, I accompanied him to a friend and associate of mine, who is involved in the HIV/AIDS field, to be counseled and for the necessary referrals to be made. However, before we departed his office, I sought his opinion on the possibility of a confirmatory test, but his response suggested pessimism, since he proclaimed that usually these results are authentic.
Nevertheless, he referred us to the St. Joseph’s Mercy hospital, which would have facilitated treatment, and care and support to some extent. However, upon arrival, the counselor invited my brother into her office, who then explained what had unraveled the previous day. She subsequently proceeded to pre test counsel him in preparation for a confirmatory test. The blood sample was taken and yet another test done. We returned for the result later in the day as we had been told. However, already resigned to our faith, we exhibited a lackluster and insouciant attitude about the result. But upon receipt, we were flummoxed, bewildered and ambivalent to see that it was conflicting from that of the initial result. And of course, you could imagine our jubilation.
Nonetheless, that jubilation was ephemeral, because those conflicting results understandably elicited a number of unanswered questions, and so the psychological burden still lingered.
My brother eventually migrated later in August 2005, and after approximately four months after his arrival in the country, he did yet another test which produced a negative result. However, during the course of this month, January 2007, he decided to pursue a final test at the exact same hospital in his country of residence, but to his consternation, the result came back reactive. Anyway, because of the inconsistencies, the blood sample was sent to the United States for a Western Blot test to be done. However, the result for this test came back on the 15th of January, and thank God, it was negative.
I wonder how many people may have been in this situation before ? I am curious to know how many people probably accepted a single result as being definitive ? how many people probably committed suicide after receiving their result without even seeking a second opinion ?
An article by Christine Johnson, “Rethinking AIDS,” posits that in the US the ELISA test is considered to be very inaccurate, and no diagnosis of HIV infection is made without a Western Blot (considered to be more accurate) as confirmation. And as we all know, in Guyana all the HIV tests search for antibodies, and one such test is the ELISA.
The article further says that the fatal flaw in HIV antibody testing is that virus isolation has never been used as a gold standard, and it is the only proper gold standard. Without virus isolation, no one knows what antibodies are causing the reaction when the test comes back positive. In addition, the more varying antibodies a person carries, the more likely that person is to possess some type of antibody that will cross-react on HIV antibody tests. In order for these tests to work properly, it must be true that a protein (also called an antigen) will react only with the antibody that matches it. In reality, antigen/antibody reactions are nonspecific. Antibodies cross-react with antigens other than the ones that originally elicited them.
Penultimately, this exact same author enumerated some common conditions among countless others which can contribute to false positives resulting from an antibody test. These are namely naturally- occurring antibodies, leprosy, tuberculosis, flu, flu vaccination, Herpes Simplex 1 and 2, upper respiratory tract infection ( cold or flu ), malaria, high levels of antibodies, alcoholic liver disease, hepatitis,haemophilia,blood with high levels of fat etc. And the list can continue.
Ultimately, I would not bury my face in the sand to the reality that a one shot test may not be accurate. It may very well be accurate. And, I do not mean to discredit or invalidate any testing site, but with the presence of other potential inhibitory and cross-reacting factors, I would strongly advise people to make an inference on the basis of two tests, instead of a single test. I have no reservations about saying this, because I have empirical evidence, and my brother is a living testimony of this ordeal.
Yours faithfully,
(name and address supplied)
