Will the Real “Hiv Test Result” Please Stand Up?

You heard it here first! Extra! Extra! Four organ recipients in Chicago test.. (Negative, Negative), Positive!

Four Chicago transplant recipients contract HIV

  • “Kuehnert said the organs came from a high-risk donor, meaning from someone who fit under one of several criteria that would increase the chances that the person might have be infected with HIV. Those include men who have had sex with another man in the preceding five years, intravenous drug users, prisoners, and people who have had sex for money or drugs.”

But no heterosexual sex? (Oh right, that only goes for Africans, I forgot…)

  • “Dave Bosch of the Gift of Hope Organ and Tissue Donation, the regional organ procurement agency that handled the donor organs, said the donor’s high-risk status was confirmed on a questionnaire. “We were aware of that from the beginning,” he said.
  • But standard testing using the enzyme-linked immunosorbent assay or ELISA antibody screening test was negative.”

Negative! Oh good! Because these tests are so accurate and reliable and predictable.. oh…

  • “When Gift of Hope was notified of the infections, it sent samples from the donor to an outside lab, Bosch said. A second ELISA test turned up negative,”

Negative! Oh good! Because these tests are so accurate and reliable and predictable.. oh….

  • “but a more sensitive test called the nucleic acid-amplification test or NAT was positive.”

Hmm. More “senstive.” That means, “more likely to ‘react’ for any reason whatsoever.” The difference between “sensitive, and accurate.” Good to know.

  • “Bosch said it is possible the HIV infection in the donor occurred within three weeks of donation — too recent for the ELISA test to detect.

Yeah… or… maybe…

Maybe the problem is that these tests are cross-reactive, non-specific, non-standardized synthetic antibody/antigen, and synthetic denatured nucleic acid assays that are actually Never “positive” or “negative,” but only shades of “reactive.” [Here]

And the “risk group” calculation,” that interpretive, subjective dance, is what pushes the doctors to regard, or interpret a test result as either “positive” or “negative.” (Or to imagine that a highly “sensitive” and wildly reactive, non-standardized “test” is necessary, despite two ’standard negative’ results.) [Here]

(Watch your ‘risk group,’ true believers. It’s the difference between a death sentence, and a new liver.)

  • “He said Gift of Hope and others involved in organ donation are weighing which test might be best against the need for the need for rapid testing.”

Rapid Testing. I’ve read about that before. Here’s how that works:

  • ”[The new rapid test’s] error rate won’t matter much in areas with a high prevalence of HIV, because in all probability the people testing false-positive will have the disease.”

So, you don’t really need the test at all. I mean, they’re not looking for a particular particle. They’re looking for a probability that the people being ‘tested’ are more likely to have illness, of any kind. (That’s why you can “safely” use the test – with a high “predictive value” – where people are starving to death. Because they’re going to get sick ANYWAY.)

  • “But if the same test was performed on 1,000 white, affluent suburban housewives – a low-prevalence population – in all likelihood all positive results will be false, and positive predictive values plummet to zero.” [Here]

Same test, same results, different group, different interpretation.

The moral of the story? It’s all in the “Risk group”! Better get yourself into a good one!

But all ribbing aside, that’s why I personally am opposed to “hiv testing,” without absolute informed consent, and a total right of refusal, without prejudice, for any patient.

Knowing Is ImportantI Support Informed Consent in Medicine

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