Zimbabwe Parliamentarians Tested for HIV

July 2, 2004

Nine members of Zimbabwe's parliament were tested for HIV at a

Population Services International (PSI) New Start voluntary counseling

and testing (VCT) center in a bold step to encourage people to learn

their HIV status through counseling and testing and to reduce the stigma

attached to HIV/AIDS. This impressive event is believed to be the

largest single group of public figures to be tested in the world.

PSI/Zimbabwe's New Start centers have spread throughout Zimbabwe with

support from the U.S. Agency for International Development (USAID) and

British Department for International Development (DFID) to become the

second largest VCT network on the continent. For more information,

visit http://www.psi.org/news/0604d.html

July 3, 2004

Message: 4

Date: Fri, 02 Jul 2004 15:37:33 -0400

From: " Karrie Carnes " <kcarnes@...>

Subject: Zimbabwe Parliamentarians Tested for HIV

> Zimbabwe Parliamentarians Tested for HIV

> Nine members of Zimbabwe's parliament were tested for HIV at a

> Population Services International (PSI) New Start voluntary counseling

> and testing (VCT) center in a bold step to encourage people to learn

> their HIV status through counseling and testing and to reduce the stigma

> attached to HIV/AIDS. This impressive event is believed to be the

> largest single group of public figures to be tested in the world.

Tested for HIV, were they? So what test was used, because

I don't know any test that tests for HIV.

I know that ELISA type tests test for a protein called p24,

and I know that Western Blot tests for gp41, gp120, gp160, etc.

But I've never heard of tests that tests for a virus called HIV.

July 3, 2004

At 05:30 PM 7/3/2004 +0200, you wrote:

>snip...

>Tested for HIV, were they? So what test was used, because

>I don't know any test that tests for HIV.

Yes, indeedy, your denialist drivel notwithstanding, . See, e.g.,

http://www.pediatriconcall.com/fordoctor/DiseasesandCondition/laboratory_diagnos\

is.asp

They note in the site above, further, that:

" ELISA is more popular & widely done test. ELISA tests have nearly 99%

sensitivity & specificity especially on repeated testing. "

ELISA tests for the ANTIBODY response. p24 is a viral protein to which the

body responds by mounting an antibody response, i.e., IgG and IgM. ELISA

may also be used for p24 antigenemia. See,

http://www.viro.med.uni-erlangen.de/KSKORN/kor.htm

The use of three ELISAs is not unusual in some resource poor areas. Western

blot follow up is relatively costly but certainly not out of the question

(especially for folks in parliament). Should they have tested negative, it

is most likely they are not HIV infected. Should they have tested positive

on 3 ELISAs, they are probably HIV-infected. You might wish to review HIV:

Carvalho M, Hamerschlak N, Vaz R, et al. Risk factor analysis and serologic

diagnosis of HIV-1/HIV-2 infection in a Brazilian blood donor population:

Validation of the World Health Organization strategy for HIV testing. AIDS

1996;10:1135-1140.

The clinical follow up generally tells the grim story, especially where

antiviral therapy is unavailable.

Maybe you could get some expert advice on this from a fellow denialist,

Pasquarelli? Oh--that's right. You can't. He bought your codswallop

and died of AIDS.

M.

Other resources:

http://www.hivguidelines.org/public_html/a-tests/a-tests-appa.htm

http://www.labnews.de/en/specials/hiv/hiv/hiv_labo.php

http://groups.google.com/groups?q=%22ELISA+tests+for%22+HIV,+antibodies & hl=en & lr\

= & ie=UTF-8 & selm=7c2rjv%24j17%241%40pegasus.csx.cam.ac.uk & rnum=2

July 3, 2004

I hope the significance of Zim's Parliamentarians being tested doesn't get

lost in the rhetoric. I think what's important here is that some of the

leaders of Zimbabwe are, in fact, finally exhibiting leadership and courage

by being tested. We can hope that more will step forward as it is acts like

this that will help destigmatize this horrible disease. My hearty

congratulations to everyone who is willing to step forward and help save

lives by their actions.

Terry Rosenlund

Re: Re: Zimbabwe Parliamentarians Tested for HIV

> At 05:30 PM 7/3/2004 +0200, you wrote:

> >snip...

> >Tested for HIV, were they? So what test was used, because

> >I don't know any test that tests for HIV.

>

> Yes, indeedy, your denialist drivel notwithstanding, . See, e.g.,

>

http://www.pediatriconcall.com/fordoctor/DiseasesandCondition/laboratory_dia

gnosis.asp

>

> They note in the site above, further, that:

> " ELISA is more popular & widely done test. ELISA tests have nearly 99%

> sensitivity & specificity especially on repeated testing. "

>

> ELISA tests for the ANTIBODY response. p24 is a viral protein to which the

> body responds by mounting an antibody response, i.e., IgG and IgM. ELISA

> may also be used for p24 antigenemia. See,

> http://www.viro.med.uni-erlangen.de/KSKORN/kor.htm

>

> The use of three ELISAs is not unusual in some resource poor areas.

Western

> blot follow up is relatively costly but certainly not out of the question

> (especially for folks in parliament). Should they have tested negative, it

> is most likely they are not HIV infected. Should they have tested positive

> on 3 ELISAs, they are probably HIV-infected. You might wish to review HIV:

> Carvalho M, Hamerschlak N, Vaz R, et al. Risk factor analysis and

serologic

> diagnosis of HIV-1/HIV-2 infection in a Brazilian blood donor population:

> Validation of the World Health Organization strategy for HIV testing. AIDS

> 1996;10:1135-1140.

>

> The clinical follow up generally tells the grim story, especially where

> antiviral therapy is unavailable.

>

> Maybe you could get some expert advice on this from a fellow denialist,

> Pasquarelli? Oh--that's right. You can't. He bought your codswallop

> and died of AIDS.

>

> M.

>

> Other resources:

> http://www.hivguidelines.org/public_html/a-tests/a-tests-appa.htm

> http://www.labnews.de/en/specials/hiv/hiv/hiv_labo.php

>

http://groups.google.com/groups?q=%22ELISA+tests+for%22+HIV,+antibodies & hl=e

n & lr= & ie=UTF-8 & selm=7c2rjv%24j17%241%40pegasus.csx.cam.ac.uk & rnum=2

>

> http://www./group/

> http://www./group/aids-africa (a group made up of Africans

worldwide)

> Join Digital Africa- an information technology group that discusses IT in

Africa at http://www./group/digafrica

>

July 3, 2004

Dear all,

Testing to know one's HIV Sero -Status should not be a big deal. Why single

out the parliamentarians any way? I strongly believe that this test should

be carried out by all people regardless of whether they hold political posts

or not. So what is the next plan? Are they going to announce publicly their

test results since they have announced that they went for a test? It is good

to have the parliamentarians test. Even if they did it secretly it would

still have the impact they are aiming at. Only five parliamentarians

accepted to go for this test? What of the rest? We need all people both big

and small to go for HIV test and not necessarily to announce because this

can bar many who may fear to be known as having gone for this test by the

public, husbands or wifes and the people they serve.

Rev. Evatt Mugarura

>From: " M. " <fiar@...>

>Reply-AIDS treatments

>AIDS treatments

>Subject: Re: Re: Zimbabwe Parliamentarians Tested for HIV

>Date: Sat, 03 Jul 2004 18:07:44 -0400

>

>At 05:30 PM 7/3/2004 +0200, you wrote:

> >snip...

> >Tested for HIV, were they? So what test was used, because

> >I don't know any test that tests for HIV.

>

>Yes, indeedy, your denialist drivel notwithstanding, . See, e.g.,

>http://www.pediatriconcall.com/fordoctor/DiseasesandCondition/laboratory_diagno\

sis.asp

>

>They note in the site above, further, that:

> " ELISA is more popular & widely done test. ELISA tests have nearly 99%

>sensitivity & specificity especially on repeated testing. "

>

>ELISA tests for the ANTIBODY response. p24 is a viral protein to which the

>body responds by mounting an antibody response, i.e., IgG and IgM. ELISA

>may also be used for p24 antigenemia. See,

>http://www.viro.med.uni-erlangen.de/KSKORN/kor.htm

>

>The use of three ELISAs is not unusual in some resource poor areas. Western

>blot follow up is relatively costly but certainly not out of the question

>(especially for folks in parliament). Should they have tested negative, it

>is most likely they are not HIV infected. Should they have tested positive

>on 3 ELISAs, they are probably HIV-infected. You might wish to review HIV:

>Carvalho M, Hamerschlak N, Vaz R, et al. Risk factor analysis and serologic

>diagnosis of HIV-1/HIV-2 infection in a Brazilian blood donor population:

>Validation of the World Health Organization strategy for HIV testing. AIDS

>1996;10:1135-1140.

>

>The clinical follow up generally tells the grim story, especially where

>antiviral therapy is unavailable.

>

>Maybe you could get some expert advice on this from a fellow denialist,

> Pasquarelli? Oh--that's right. You can't. He bought your codswallop

>and died of AIDS.

>

> M.

>

>Other resources:

>http://www.hivguidelines.org/public_html/a-tests/a-tests-appa.htm

>http://www.labnews.de/en/specials/hiv/hiv/hiv_labo.php

>

>http://groups.google.com/groups?q=%22ELISA+tests+for%22+HIV,+antibodies & hl=en & l\

r= & ie=UTF-8 & selm=7c2rjv%24j17%241%40pegasus.csx.cam.ac.uk & rnum=2

>

_________________________________________________________________

FREE pop-up blocking with the new MSN Toolbar – get it now!

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July 4, 2004

Message: 4

Date: Sat, 03 Jul 2004 18:07:44 -0400

From: " M. " <fiar@...>

Subject: Re: Re: Zimbabwe Parliamentarians Tested for HIV

At 05:30 PM 7/3/2004 +0200, you wrote:

> >snip...

> > Tested for HIV, were they? So what test was used, because

> > I don't know any test that tests for HIV.

> >

> Yes, indeedy, your denialist drivel notwithstanding, . See, e.g.,

>

http://www.pediatriconcall.com/fordoctor/DiseasesandCondition/laboratory_dia

gnosis.asp

>

> They note in the site above, further, that:

> " ELISA is more popular & widely done test. ELISA tests

> have nearly 99% sensitivity & specificity especially on

> repeated testing. "

Yes, , and you're the sort who believe that

Reverend Moon is God, and you're going to give

him all your money.

You forgot to mention that, in the words of the WHO:

Source:

http://www.who.int/bct/Main_areas_of_work/BTS/HIV_Diagnostics/

Evaluation_reports/Operational%20Characteristics_HIV%20Report9_10.pdf

" When a single screening assay is used for testing in a population

with a very low prevalence of HN infection, the probability that

a person is infected when a positive test result is obtained (i.e.,

the positive predictive value) is very low, since the majority of

people with positive results are not infected. "

In other words, these tests are so " specific and sensitive " ,

that the HUGE majority of positives are FALSE POSITIVES.

And oh yeah, I forgot, when you repeat them, and all of a

sudden, they're " 99% accurate " .

You forget, me bucko, that Zimbabwe is well within

the malaria zone, and that mycobacteria, including malaria,

are known to give false positives when using ELISA (p24 or

" protein 24 " ) tests.

And if you're denying the statement that ELISA

does not test for HIV, then you are the one who

is driveling.

Also, on the specificity in low prevalence populations like

Italy's, here are the results of an Italian armed forces

blood transfusion center study.

Source: http://www.certi.org/CMA/newsletter/v03n01.pdf

Table II (page 4 of 8)

HIV Screening in Military Blood Transfusion Centers

Number of donations: 25,562

Number of blood donations ELISA positive: 31

Number of blood donations after confirmation test: 2

In other words: 25,562 people were tested, 31 came

up positive, and after further testing, 2 of those remained

positive. And this in a country (Italy) that has very little malaria

or other factors that cause false positives in these tests.

So, what caused these people's tests to be false positive,

I wonder?

And of course, 2 true positives out of 31 initial positives,

means 2/31 or 6.45% were true positive, and 93.55%

were false positive.

So where does that leave your " nearly 99% sensitivity &

specificity especially on repeated testing " ? Other than in

the dust, of course?

The truth is, I would not trust a positive ELISA test in

Africa at all.

July 4, 2004

,

I won't go into the discussion whether or not there are tests for

HIV, and if those tests are testing what they suppose to test.

We have been here before. Tests or not, tested or not, people are

infected and a lot of them die. I know you claim their cause of death

is not AIDS, but even that I find rather irrelevant (in this matter).

On this list, as well as on Aids Africa, are people who are infected,

affected and/ or work in the field. In other words.. HIV/AIDS is a

reality they (we) work/ life with. I think that is the starting

point. That is why we are here in this group (and in the Africa Aids

group).

Think about it.

Caroline

> > >snip...

> > > Tested for HIV, were they? So what test was used, because

> > > I don't know any test that tests for HIV.

> > >

> > Yes, indeedy, your denialist drivel notwithstanding, . See,

e.g.,

> >

>

http://www.pediatriconcall.com/fordoctor/DiseasesandCondition/laborato

ry_dia

> gnosis.asp

> >

> > They note in the site above, further, that:

> > " ELISA is more popular & widely done test. ELISA tests

> > have nearly 99% sensitivity & specificity especially on

> > repeated testing. "

>

> Yes, , and you're the sort who believe that

> Reverend Moon is God, and you're going to give

> him all your money.

>

> You forgot to mention that, in the words of the WHO:

>

> Source:

> http://www.who.int/bct/Main_areas_of_work/BTS/HIV_Diagnostics/

> Evaluation_reports/Operational%20Characteristics_HIV%

20Report9_10.pdf

>

> " When a single screening assay is used for testing in a population

> with a very low prevalence of HN infection, the probability that

> a person is infected when a positive test result is obtained (i.e.,

> the positive predictive value) is very low, since the majority of

> people with positive results are not infected. "

>

> In other words, these tests are so " specific and sensitive " ,

> that the HUGE majority of positives are FALSE POSITIVES.

>

> And oh yeah, I forgot, when you repeat them, and all of a

> sudden, they're " 99% accurate " .

>

> You forget, me bucko, that Zimbabwe is well within

> the malaria zone, and that mycobacteria, including malaria,

> are known to give false positives when using ELISA (p24 or

> " protein 24 " ) tests.

>

> And if you're denying the statement that ELISA

> does not test for HIV, then you are the one who

> is driveling.

>

> Also, on the specificity in low prevalence populations like

> Italy's, here are the results of an Italian armed forces

> blood transfusion center study.

>

> Source: http://www.certi.org/CMA/newsletter/v03n01.pdf

>

> Table II (page 4 of 8)

> HIV Screening in Military Blood Transfusion Centers

>

> Number of donations: 25,562

> Number of blood donations ELISA positive: 31

> Number of blood donations after confirmation test: 2

>

> In other words: 25,562 people were tested, 31 came

> up positive, and after further testing, 2 of those remained

> positive. And this in a country (Italy) that has very little malaria

> or other factors that cause false positives in these tests.

>

> So, what caused these people's tests to be false positive,

> I wonder?

>

> And of course, 2 true positives out of 31 initial positives,

> means 2/31 or 6.45% were true positive, and 93.55%

> were false positive.

>

> So where does that leave your " nearly 99% sensitivity &

> specificity especially on repeated testing " ? Other than in

> the dust, of course?

>

> The truth is, I would not trust a positive ELISA test in

> Africa at all.

>

July 4, 2004

Hello all--

It's getting a bit technical here so please read if you enjoy the deeper

debate--some important points ARE relevant to the group, that is to say

that adequate screening for HIV needs to be a part and parcel of testing

procedures.

At 08:01 PM 7/4/2004 +0200, you wrote:

>snip...>

>

>Yes, , and you're the sort who believe that

>Reverend Moon is God, and you're going to give

>him all your money.

No, dearie, I believe more in science than I do psychotics who spout drivel

and distort data to suit whatever peculiar agenda they may have. I would

give you some food happily if you were hungry but I wouldn't give you any

money.

>You forgot to mention that, in the words of the WHO:

Indeed, I did not mention this report since I had not read it--but thanks

for posting it! An excellent report all should read closely and it will

become clear to one and all that you selectively use bits, sorta like Rush

Limbaugh, to make some point that is completely at odds with what the

document says! In other words, you make crap up to support your delusion.

Indeed, you will note on the second page of the document that it lists a

series of ELISA tests by different companies that test for ANTIBODY to

HIV-1. This is different from testing for p24. Do you understand that there

is a distinction? Do you understand what is used in initial screening assays?

>Source:

>http://www.who.int/bct/Main_areas_of_work/BTS/HIV_Diagnostics/Evaluation_report\

s/Operational%20Characteristics_HIV%20Report9_10.pdf

>

> " When a single screening assay is used for testing in a population

>with a very low prevalence of HN infection, the probability that

>a person is infected when a positive test result is obtained (i.e.,

>the positive predictive value) is very low, since the majority of

>people with positive results are not infected. "

Ah, one might note that in Africa, many nations have

a) a HIGH prevalence and

use of MULTIPLE assays is undertaken where western blot is not feasible.

And, of course, as seen below, you elided the sentence that finishes this

paragraph as it was inconvenient to your argument.

>In other words, these tests are so " specific and sensitive " ,

>that the HUGE majority of positives are FALSE POSITIVES.

Not in an area with high prevalence. Zimbabwe is an area of high

prevalence. Not when an ELISA is repeated. Now, if you say that a person

with few risk factors is tested with a single ELISA and is then declared

HIV+, this indeed CAN be a terrible misdiagnosis--and I quite agree that it

is very possibly happening. But unfortunately, the fact there are such

diagnoses does not serve as a basis for arguing that HIV does not exist or

cause AIDS. Did you ask Pasquarelli?

>And oh yeah, I forgot, when you repeat them, and all of a

>sudden, they're " 99% accurate " .

In an area of high prevalence and where there is more than one test done.

And, you add in the clinical presentation, it's unfortunately likely that a

person with 3 positive ELISAs has HIV. A virus that exists and causes AIDS.

>You forget, me bucko, that Zimbabwe is well within

>the malaria zone, and that mycobacteria, including malaria,

>are known to give false positives when using ELISA (p24 or

> " protein 24 " ) tests.

The " malaria " connection is a false one. There IS no major issue with cross

reactivity, much though denialists would like to make a mountain out of a

molehill...see below.

>And if you're denying the statement that ELISA

>does not test for HIV, then you are the one who

>is driveling.

To the contrary! ELISA is a GENERAL test, as the different URLs attests

(which I guess you summarily dismissed since they conflict with your

worldview). It can be used to identify a variety of infections. As such, it

may be used to test for different proteins, and in general is used to look

for antibodies that are generated as a result of infection to HIV (IgG,

IgM) or can be used to evaluate the presence of p24. Do you comprehend the

distinction? In either case, however, one is testing for the presence of

HIV infection.

>Also, on the specificity in low prevalence populations like

>Italy's, here are the results of an Italian armed forces

>blood transfusion center study.

>

>Source: http://www.certi.org/CMA/newsletter/v03n01.pdf

>

>Table II (page 4 of 8)

>HIV Screening in Military Blood Transfusion Centers

>

>Number of donations: 25,562

>Number of blood donations ELISA positive: 31

>Number of blood donations after confirmation test: 2

>

>In other words: 25,562 people were tested, 31 came

>up positive, and after further testing, 2 of those remained

>positive. And this in a country (Italy) that has very little malaria

>or other factors that cause false positives in these tests.

What they showed was that the incidence of HIV in this population declined

(happily) from 33.35/100,000 in 1987 to 0.95/100,000 in 1995. The document

is from 1997.

The table is not referenced in the text (maybe I missed it?), so it is

unclear what generation of ELISA they used to test the blood. Indeed, a

false positive rate on a SINGLE test may be high; single tests in a low

prevalence population have a low specificity. No one argues with that point

which is really all the table suggests.

>So, what caused these people's tests to be false positive,

>I wonder?

Ah, there were NOT 25,562 people tested. There were 25,562 blood donations.

We have no idea how any people donated more than once. To rely on this one

table, not fully discussed in the text provided but a text that does not

dispute the connection between HIV and AIDS by any means, is disingenuous

in the extreme. It is also just ridiculous, again, because use of a single

ELISA is not recommended anywhere by anyone.

Indeed, the reality is that they did find two HIV+ blood donations upon

REPEAT testing and confirming follow up. Which means these two people in

this ONE study of blood donations in a low prevalence area were in fact HIV

infected. So to use this as part of a basis for denialist argument is just

ridiculous.

>So where does that leave your " nearly 99% sensitivity &

>specificity especially on repeated testing " ? Other than in

>the dust, of course?

LOL...you are distorting the data to suit your own denialist ends. First,

in terms of sensitivity, there is no effect. If a test is negative by

ELISA, the chances are a person IS negative, unless they have recently been

infected and the body has not yet generated antibodies. In terms of

specificity in a LOW prevalence area, a SINGLE test may indeed be a false

positive. In the WHO document you thoughtfully cite, they note:

" When a single screening assay is used for testing in a population with a

very low prevalence of HN infection, the probability that a person is

infected when a positive test result is obtained (i.e., the positive

predictive value) is very low, since the majority of people with positive

results are not infected. This problem occurs even when a test with high

specificity is used. Accuracy can be improved if a second confirmatory test

is used to retest all those samples found positive by the first test. Those

found negative by the test are considered negative for antibodies to HIV . "

Further, if you read on, you will see that this WHO document makes specific

recommendations for repeat testing. They use a HIGH standard of presumption

for blood donations or organ transplants--a single ELISA, consider it

positive. Don't risk contaminating the blood supply. By contrast, for an

individual, they use a HIGH standard for assuring that an individual is

confirmed infected. In the absence of a western blot, THREE positive ELISAs

are considered " HIV+ " while 2 and one negative are " indeterminate. " One can

use other sequelae, like clinical effects, CD4 count if available (and

increasingly, lower cost technologies are making this more widely

available) or an algorithm based on white blood cell count to establish an

HIV infection. And honey, people DO find out TOO damn fast if they are

HIV+, especially in developing nations, where progression may be more rapid

(esp. in the context of parasitic infections pushing to a Th2 immune response).

Sadly, it seems seductively convincing until you deconstruct your

nonsense...and until you watch people die of AIDS. The fact that such

weak-kneed evidence is used with a result that it influences people like

Mbeki which in turn results in reduced efforts to help treat people which

in turn causes increased suffering and death that could be avoided is

simply despicable.

It's bad enough that pharmaceutical companies block access to ARV through

lawsuits and horrible trade agreements that corrupt or ignorant governments

are bullied and bribed into signing, pushed by the US government and its

noxious Trade Representative, that zealot Zoellick. It's bad enough that

simple interventions like food, water, a multivitamin and more vigorous

exploration of traditional medicines are denied because of corruption,

diverting resources to usurious World Bank and IMF debt payments, and the

general bigotry of some in medical science against these inexpensive

interventions. It's hard enough when local resources, healthcare

infrastructure and trained personnel are not strengthened because of

corruption, greed, shortsighted stupidity and ignorance. That good

positions are taken by people dying of AIDS or fleeing to better jobs in

Europe and America.

But to have your denialist crap piled on top of that is just too sickening

for words. I notice you snipped out the note on your dead denialist buddy

Pasquarelli. How many more men, women and children have you helped hasten

to their deaths by promoting this psychobabble? Perhaps we'll get to meet

them when we die.

M.

***

For example, in this study, they used " repeated " testing to confirm HIV

infection.

Sentjens RE, Sisay Y, Vrielink H, Kebede D, Ader HJ, Leckie G, Reesink HW.

Prevalence of and risk factors for HIV infection in blood donors and

various population subgroups in Ethiopia. Epidemiol Infect. 2002

Apr;128(2):221-8.

Blood Bank North Holland, Amsterdam, The Netherlands.

The aim was to determine the prevalence of HIV infection and risk factors

for HIV infection in various population subgroups in Ethiopia. Serum panels

from blood donors (n = 2610), from various population subgroups in Ethiopia

were tested for anti-HIV-1/2 by ELISA. All ELISA repeatedly reactive

samples were subjected for confirmation by immunoblot (IB) and anti-HIV-1

and anti-HIV-2 specific ELISAs. 155/2610 (5.9%) blood donors were HIV-1

infected. Of pregnant women, 84/797 (10.5%) were HIV-1 infected, and 1/797

(0.1%) was HIV-2 infected. 1/240 (0.4%) individuals from the rural

population were HIV-1 infected. 198/480 (41.3%) female attendees, and

106/419 (25.3%) male attendees at sexual transmitted disease (STD) clinics

were HIV-1 infected. One (0.2%) male, and 2 (0.4%) female STD patients were

infected with both HIV-1 and HIV-2. It was concluded that the prevalence of

HIV-1 infection varied from 0.4% among urban residents to 25.3-41.3% among

STD attendees. There is a low prevalence of HIV-2 present in Ethiopian

subjects. Risky sexual behaviour is significantly associated with

HIV-infection in Ethiopia.

***

Malaria causing false positives on HIV tests:

From: (njb35@...)

Subject: Re: HIV and malarial X-reactivity

View: Complete Thread (8 articles)

Original Format

Newsgroups: misc.health.aids

Date: 1999/03/09

Bullington wrote in message <7c29n6$4hi@...>...

>

> wrote in message <7c1e6g$p1l$1@...>...

>>

>>I've been trying to find the papers where the cross-reactivity of the

>>HIV-tests to malarial antigens was supposedly discussed. I found the

>>following...

>

>Did you mean to malarial antibodies?

>

Er, yeah. Looks like I mixed two different concepts (it had been a busy day

;-)

" HIV " antibodies being produced to malarial antigens.

HIV tests cross-reacting with anti-malarial antibodies.

>

>Only the last study seems to address the issue of cross reactivity of HIV

>and malaria in serological tests. The others deal with the issue of

>correlation or association between HIV infection and plasmodium infection.

Yes - since they found little correlation between malaria and HIV I

concluded from this that the malaria infections did not affect the outcome

of the HIV tests - otherwise far more of the malarial patients would have

come up HIV+. The papers didn't look specifically for it, but that

conclusion can be drawn implicitly from the fact that they could only find

HIV in a minority of malarial patients. If false-positives were affecting

test results significantly that would not have happened.

>This is an interesting question, particularly since malaria is on the rise

>in most regions where the it is endemic (just look at the data from the

>first paper you posted from Uganda to see this). Incidently, as you may

>have read on the news recently, the WWF is lobbying for a total global ban

>on DDT, which is the only effective agent many developing nations have to

>fight malaria.

>

Hmmm. Aren't there better insecticides these days, or are they priced out

of the reach of these people? :-/ Apparently every organism on the planet

has DDT in it in some amount (WARNING - HIGH SCHOOL FACT ONLY!).

>

>Here's another recent study on correlations (or lack thereof) between HIV

>and plasmodium which stresses the need for more data, this may be the one

>you referred to above but if not, here it is:

>

It wasn't - but it brought up another point I notcied. There is an

interaction between malaria and HIV - apparently those infected with malaria

AND HIV don't get such a bad reaction to malaria. Since a lot of the damage

from malaria results from the immune response to the infection, and HIV

attenuates the immune system, it sort of makes sense.

The paper I was referring to was

*******************

JAMA 1988 Jan 22-29;259(4):545-9

The association between malaria, blood transfusions, and HIV seropositivity

in a pediatric population in Kinshasa, Zaire.

Greenberg AE, Nguyen-Dinh P, Mann JM, Kabote N, Colebunders RL, Francis H,

Quinn TC, Baudoux P, Lyamba B, Davachi F, et al

Malaria Branch, Centers for Disease Control, Atlanta, GA 30333.

Since Plasmodium falciparum malaria is a frequent cause of anemia among

African children, and blood transfusions, unscreened for human

immunodeficiency virus (HIV) antibody, are used frequently in the treatment

of children with severe malaria, the relationships between malaria,

transfusions, and HIV seropositivity were investigated in a pediatric

population in Kinshasa, Zaire. In a cross-sectional survey of 167

hospitalized children, 112 (67%) had malaria, 78 (47%) had received

transfusions during the current hospitalization, and 21 (13%) were HIV

seropositive. Ten of the 11 seropositive malaria patients had received

transfusions during the current hospitalization; pretransfusion specimens

were available for four of these children and were seronegative. Of all

blood transfusions, 87% were administered to malaria patients, and there was

a strong dose-response association between transfusions and HIV

seropositivity. A review of 1000 emergency ward records demonstrated that

69% of transfusions were administered to malaria patients, and 97% of

children who received transfusions had pretransfusion hematocrits of 0.25 or

less (less than or equal to 25%). The treatment of malaria with blood

transfusions is an important factor in the exposure of Kinshasa children to

HIV infection.

PMID: 3275815, UI: 88091263

******************

It astonishes me that so much of this data has been available for a decade,

and yet this particular myth about HIV/malaria x-reactivity is still

propogated. I ought to mention that I found not a single piece of evidence

that the HIV tests were affected by malaria infection out of those 46 refs.

There _were_ a few papers that suggested something in their titles, but no

abstracts were available.

******************

N Engl J Med 1986 Mar 6;314(10):647-8

Antibodies to HTLV-III/LAV in Venezuelan patients with acute malarial

infections.

Volsky DJ, Wu YT, son M, Dewhurst S, Sinangil F, Merino F,

L, Godoy G

Publication Types:

Letter

PMID: 3511375, UI: 86118517

N Engl J Med 1986 Aug 14;315(7):457-8

Possible nonspecific association between malaria and HTLV-III/LAV.

Biggar RJ

Publication Types:

Letter

PMID: 3016540, UI: 86284878

BMJ 1988 Jul 2;297(6640):30-1

Relation between falciparum malaria and HIV seropositivity in Ndola, Zambia.

Simooya OO, Mwendapole RM, Siziya S, Fleming AF

Tropical Diseases, Research Centre, Ndola, Zambia.

PMID: 3044486, UI: 88310159

Lancet 1992 Dec 5;340(8832):1412-3

Spurious malarial antibodies in HIV infection.

Parry JV, Richmond J, N, Noone A

Publication Types:

Letter

Comments:

Comment in: Lancet 1993 Feb 13;341(8842):441-2

PMID: 1360116, UI: 93078552

******************

The last one also goes the wrong way, since the fact that HIV infection

might produce anti-malarial antibodies is irrelevant.

I'm entirely non-plussed as to HOW the Perth group can back up their

hypothesis that the HIV tests are flawed. Some of their refs I found

yesterday, and IN NO WAY could the conclusion be drawn that malaria was

confounding the HIV results! I've looked through a few of their other refs

this morning, and it's completely laughable - they quote out of context, and

ignore results from the same paper that go against their views!

Example - in their June 93 paper

In drug addicts there is a strong association between high serum globulin

levels and a positive HIV antibody test and this was the " only variable

which remained significant in a logistic regression model " ; (52)

Ref 52 is the following

********************

Alcohol Clin Exp Res 1988 Oct;12(5):687-90

Specificity of antibody tests for human immunodeficiency virus in alcohol

and parenteral drug abusers with chronic liver disease.

Novick DM, Des Jarlais DC, Kreek MJ, Spira TJ, Friedman SR, Gelb AM, Stenger

RJ, Schable CA, Kalyanaraman VS

Department of Medicine, Beth Israel Medical Center, New York, NY 10003.

Parenteral drug abusers are at risk for acquired immunodeficiency syndrome

(AIDS), which is caused by human immunodeficiency virus (HIV). We tested

stored sera for antibody to HIV (anti-HIV) using two enzyme-linked

immunosorbent assay (ELISA) methods and Western blot. The patients were

parenteral drug abusers who had undergone percutaneous liver biopsy for

chronic liver disease. Current or former alcohol abuse was noted in 88 (80%)

of the 110 patients. The sensitivities of the two ELISA tests in comparison

with Western blot, the more specific test for HIV, were 100 and 94%,

respectively; the specificities were 94 and 99%. Western blot was positive

in 36 (33%) of 110 patients. False-positive ELISA reactions for anti-HIV

were seen in five (7%) of 70 patients with negative Western blot analyses.

Compared to true-negatives, false-positives had significantly more years of

alcohol abuse, younger ages of onset of alcohol abuse, greater frequencies

of jaundice and edema, higher levels of alkaline phosphatase, total

billirubin, total protein, and globulins, and lower levels of serum albumin.

In a stepwise logistic regression, only hyperglobulinemia was significantly

associated with a false-positive anti-HIV. We conclude that: (a) ELISA tests

for anti-HIV are useful for screening abusers of alcohol and parenteral

drugs with chronic liver disease for HIV infection, but positive results

must be confirmed with more specific tests such as Western blot; (

false-positive ELISA reactions in this population are associated with

populations of patients with alcoholism or liver disease.

PMID: 3067617, UI: 89148678

*****************

Hyperglobinaemia was the only factor in FALSE-POSITIVE HIV results, not

POSITIVE HIV results, and the Perth group were using this as evidence

against WB testing when the false-positives were only found using ELISA's

and the WB's gave negative results!

This is completely disingenuous, misleading and dangerous.

Sorry if I'm spouting a little but this is the first time I've looked into

the Perth group's claims properly, and I'm not impressed at all. I had

thought that they were quoting papers that were simply contradictory to

those supporting the HIV tests, but they weren't even doing that. This one

particular article had over 160 refs, some of them to other Perth papers, so

ploughing through them is a bind - but obviously well worthwhile if it shows

this sort of scam.

Cheers

July 5, 2004

> Message: 2

> Date: Sun, 04 Jul 2004 20:23:09 -0000

> From: " yamanjanl " <yamanjanl@...>

> Subject: Re: Zimbabwe Parliamentarians Tested for HIV

>

> ,

>

> I won't go into the discussion whether or not there are tests for

> HIV, and if those tests are testing what they suppose to test.

Well we pretty much know what they test for. The ELISA

tests for a protein labeled p24, and how unique that protein

is to HIV is anyone's guess. What is an established fact, is

that there are many factors that can cause a " false positive "

(a positive ELISA screening test, that isn't followed by a

positive Western Blot confirmation test, for instance).

The WHO/UNAIDS agrees with that (see the excerpt

in my original post).

> We have been here before. Tests or not, tested or not, people are

> infected and a lot of them die.

Without the tests, no one knows. The tests are the only difference

between " AIDS " and whatever actual disease they have.

Someone with tuberculosis and a positive ELISA or Western Blot

is labeled " AIDS " . Someone with tuberculusis and a negative test

is labeled " tuberculosis " .

Therefore, this test makes all the difference.

> I know you claim their cause of death

> is not AIDS,

I make no such claim, I have no idea. That's the point.

I'm just searching for answers. I leave the belief and

the certainties to all the activists.

> but even that I find rather irrelevant (in this matter).

> On this list, as well as on Aids Africa, are people who are infected,

> affected and/ or work in the field. In other words.. HIV/AIDS is a

> reality they (we) work/ life with.

A perceived reality. A perceived reality, that is pumped up

by the WHO/UNAIDS and it's ANC (antenatal clinic) surveys.

> I think that is the starting point. That is why we

> are here in this group (and in the Africa Aids group).

> Think about it.

I have, and I'm still not convinced that ELISA screening tests

in Africa are at all reliable.

No one in New York will come down with malaria this year.

And yet, there are regions of Kenya that are endemic with malaria.

Malaria is one of the many pathogens that cause an ELISA to be

false positive.

So why am I to believe that a positive ELISA in New York is as

reliable as a positive ELISA in Kenya? What is there to stop me

believing that most of the positive screening tests in Africa are

false positives?

July 5, 2004

At 09:23 PM 7/5/2004 +0200, you wrote:

> > Message: 2

> > Date: Sun, 04 Jul 2004 20:23:09 -0000

> > From: " yamanjanl " <yamanjanl@...>

> > Subject: Re: Zimbabwe Parliamentarians Tested for HIV

> >

> > ,

> >

> > I won't go into the discussion whether or not there are tests for

> > HIV, and if those tests are testing what they suppose to test.

>

>Well we pretty much know what they test for. The ELISA

>tests for a protein labeled p24, and how unique that protein

>is to HIV is anyone's guess.

The ELISA used for screening for HIV infection tests for ANTIBODIES to HIV.

ELISA for p24 is a distinct test not really used for screening for HIV

infection. See, e.g.,

http://www.afroaidsinfo.org/content/hivandyou/HivAffectAdults/tests.htm

> What is an established fact, is

>that there are many factors that can cause a " false positive "

I dealt with this elsewhere. Repeating the same misinformation does not

make it true. It didn't work for Bush/Cheney/Rumsfeld/Rice and and

it won't work for you either, disingenuous claims of agnosticism

notwithstanding.

M.

July 5, 2004

At 09:23 PM 7/5/2004 +0200, you wrote:

>snip...

>Well we pretty much know what they test for. The ELISA

>tests for a protein labeled p24, and how unique that protein

>is to HIV is anyone's guess.

Oh--and the uniqueness of p24 in HIV? You can do a BLAST search and

establish its genetic sequence. The core protein of HIV gag is pretty

unique. A lovely treatise here provides instructions for how to do so:

http://www.virusscience.org/newsgap_debate/3C0409DF00000029.html

There, he notes:

" Even the other lentiviral p24 proteins are quite different from HIV-1 p24.

The Gag matrix proteins from other retroviruses would not be considered to

be related at all if it were not known that they were viral core

nucleocapsid proteins. "

M.

July 5, 2004

> Message: 4

> Date: Sun, 04 Jul 2004 18:46:00 -0400

> From: " M. " <fiar@...>

> Subject: Re: Re: Zimbabwe Parliamentarians Tested for HIV

> >You forgot to mention that, in the words of the WHO:

>

> Indeed, I did not mention this report since I had not read it--but thanks

> for posting it! An excellent report all should read closely and it will

> become clear to one and all that you selectively use bits, sorta like Rush

> Limbaugh, to make some point that is completely at odds with what the

> document says! In other words, you make crap up to support your delusion.

> Indeed, you will note on the second page of the document that it lists a

> series of ELISA tests by different companies that test for ANTIBODY to

> HIV-1. This is different from testing for p24. Do you understand that

there

> is a distinction? Do you understand what is used in initial screening

assays?

>

> > Source:

> >

http://www.who.int/bct/Main_areas_of_work/BTS/HIV_Diagnostics/Evaluation_rep

orts/Operational%

> > 20Characteristics_HIV%20Report9_10.pdf

> >

> > " When a single screening assay is used for testing in a population

> >with a very low prevalence of HN infection, the probability that

> >a person is infected when a positive test result is obtained (i.e.,

> >the positive predictive value) is very low, since the majority of

> >people with positive results are not infected. "

>

> Ah, one might note that in Africa, many nations have

> a) a HIGH prevalence and

> use of MULTIPLE assays is undertaken where western blot is not

feasible.

That't not the point. The point is that even the WHO/UNAIDS

states that with one test, in " low prevalence " populations, a single

positive ELISA is usually a false positive.

And let's not mince words here - these tests should be

correct first time out. If they truly had " 99% " sensitivity

and specificity, it wouldn't matter if it was used in

high or low frequency populations.

> And, of course, as seen below, you elided the sentence that finishes this

> paragraph as it was inconvenient to your argument.

> >In other words, these tests are so " specific and sensitive " ,

> >that the HUGE majority of positives are FALSE POSITIVES.

>

> Not in an area with high prevalence. Zimbabwe is an area of high

> prevalence.

You don't know that. There is no rational reason why

HIV in Zimbabwe would spread like wildfire, when in

the rest of the world it is a very rare infection limited to

high risk groups.

> Not when an ELISA is repeated.

Why? Why wouldn't a single test be sufficient?

> Now, if you say that a person

> with few risk factors is tested with a single ELISA and is then declared

> HIV+, this indeed CAN be a terrible misdiagnosis--and I quite agree that

it

> is very possibly happening. But unfortunately, the fact there are such

> diagnoses does not serve as a basis for arguing that HIV does not exist or

> cause AIDS. Did you ask Pasquarelli?

>

> >And oh yeah, I forgot, when you repeat them, and all of a

> >sudden, they're " 99% accurate " .

>

> In an area of high prevalence and where there is more than one test done.

> And, you add in the clinical presentation, it's unfortunately likely that

a

> person with 3 positive ELISAs has HIV. A virus that exists and causes

AIDS.

>

> >You forget, me bucko, that Zimbabwe is well within

> >the malaria zone, and that mycobacteria, including malaria,

> >are known to give false positives when using ELISA (p24 or

> > " protein 24 " ) tests.

>

> The " malaria " connection is a false one. There IS no major issue with

cross

> reactivity, much though denialists would like to make a mountain out of a

> molehill...see below.

Ok, see if you disagree with the Ehrlich Institute for tropical

medicine

in Munich: http://www.pei.de/themen/hivdiasa.htm#stoer

(For an english language list of false positives causing factors, and

footnotes, see: http://www.virusmyth.net/aids/data/cjtestfp.htm )

> >And if you're denying the statement that ELISA

> >does not test for HIV, then you are the one who

> >is driveling.

>

> To the contrary! ELISA is a GENERAL test, as the different URLs attests

> (which I guess you summarily dismissed since they conflict with your

> worldview). It can be used to identify a variety of infections. As such,

it

> may be used to test for different proteins, and in general is used to look

> for antibodies that are generated as a result of infection to HIV (IgG,

> IgM) or can be used to evaluate the presence of p24. Do you comprehend the

> distinction? In either case, however, one is testing for the presence of

> HIV infection.

In neither case is one testing for a specific virus called HIV.

I think this is where all the possibilities for false positives stem from.

> >Also, on the specificity in low prevalence populations like

> >Italy's, here are the results of an Italian armed forces

> >blood transfusion center study.

> >

> >Source: http://www.certi.org/CMA/newsletter/v03n01.pdf

> >

> >Table II (page 4 of 8)

> >HIV Screening in Military Blood Transfusion Centers

> >

> >Number of donations: 25,562

> >Number of blood donations ELISA positive: 31

> >Number of blood donations after confirmation test: 2

> >

> >In other words: 25,562 people were tested, 31 came

> >up positive, and after further testing, 2 of those remained

> >positive. And this in a country (Italy) that has very little malaria

> >or other factors that cause false positives in these tests.

>

> What they showed was that the incidence of HIV in this population declined

> (happily) from 33.35/100,000 in 1987 to 0.95/100,000 in 1995. The document

> is from 1997.

>

> The table is not referenced in the text (maybe I missed it?), so it is

> unclear what generation of ELISA they used to test the blood. Indeed, a

> false positive rate on a SINGLE test may be high; single tests in a low

> prevalence population have a low specificity. No one argues with that

point

> which is really all the table suggests.

Well they should.

I don't see how a test would be unspecific in a population with

few HIV infections, but highly specific in a population with

a lot of infections. Just because the number of infections

of the overall population.

Maybe low incidence populations are so because they

have few other, false positive causing pathogens (malaria,

leprosy, malnutrition, etc.).

Especially when there are so many pathogens that are known

to cause false positive results that are specific to that " high

incidence " population.

July 5, 2004

At 12:00 AM 7/6/2004 +0200, you wrote:

>snip

> > Ah, one might note that in Africa, many nations have

> > a) a HIGH prevalence and

> > use of MULTIPLE assays is undertaken where western blot is not

>feasible.

>

>That't not the point. The point is that even the WHO/UNAIDS

>states that with one test, in " low prevalence " populations, a single

>positive ELISA is usually a false positive.

Indeed it may be--but that does not invalidate the test!

>And let's not mince words here

Darling, I have RARELY been accused of mincing words.

>- these tests should be

>correct first time out. If they truly had " 99% " sensitivity

>and specificity, it wouldn't matter if it was used in

>high or low frequency populations.

Nonsense, utter and complete. For example, ELISA tests are only part of the

diagnostic armamentarium for establishing infection by hepatitis C. See:

http://med-lib.ru/english/oxford/hep_prob.shtml

They note: " Tests for antibodies to HCV are widely available but the false

positive rate is high. Repeat assays using different varieties of antibody,

or the immunoblot technique as opposed to the enzyme-linked immunosorbent

assay (ELISA), improve the specificity. The polymerase chain reaction (PCR)

method will identify viral RNA in the serum and is the most accurate

technique, but at the present time it is expensive and not widely available. "

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Zimbabwe Parliamentarians Tested for HIV

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