Should I Take the Test?

Dear Christine,

Iím head over heels in love with a wonderful woman who wants me to get an HIV test. After reading all the information about the unreliability and potential for false positives, Iím terrorized by the idea of taking a test that may ruin our relationship and side-line my entire life.

Iím a very healthy person and not in any risk group. I eat well, workout five days a week, usually don't get the flu or even a cold. I don't take drugs and never have. Yet Iím worried sick over the idea of HIV testing. Since this situation came up, I sit at work staring at the walls, canceling meetings, near tears.

I know you donít tell people what to do, but please can you help me? This is the woman of my dreams and I donít want to lose her.

Desperate in Detroit

Dear Desperate,

Realistically speaking, you have very little to worry about. The vast majority of healthy, risk-free people like you who take the so-called HIV test do not get positive results. In the past 20 years with all the millions and millions of tests that have been administered in this country, the official estimate of HIV positive Americans is 650,000 to 900,00 which is the same unverified estimate thatís been tossed around since 1996. Another encouraging fact to consider is that only a small percentage of people in AIDS risk groups ever even test HIV positive.

As a healthy, risk-free person, your chances of coming up positive are really quite small. The test generally given in the US as a screening, the HIV ELISA , was actually designed to prevent people like you from getting positive results. As Alive & Well advisory board member Dr Rodney Richards who was part of the team that created the HIV ELISA explains, when an unacceptable number of healthy, risk free blood donors came up positive in initial screening surveys, scientists went back and intentionally recalibrated the test to make this confounding possibility less likely. Today, HIV ELISAs are run on serum that has been diluted 400 times, an extraordinarily high dilution rate that apparently keeps positive results from occurring in too many risk free individuals.

In this regard, HIV tests are quite different from other antibody tests which are conducted on undiluted serum (also called ďneatĒ or straightĒ serum). For example, ELISAs that check for antibodies to hepatitis A and B, rubella, syphilis, cryptococcus, and histoplasmosisóto name just a fewóall use straight serum. And ELISAs that do require diluted serum use rates far below that used with HIV ELISAs. Antibody tests for Epstein-Barr are run at 1:10; measles, mumps and varicella use a rate of 1:16; for cytomegalovirus (CMV) itís 1:20. Slight dilutions actually improve the accuracy of positive results in identifying people with active infections.

In the case of the HIV ELISA however, the extreme dilution rate is not thought to compromise test accuracy. Since there is no explanation for the 1:400 dilution in the ELISA kit documentation or the medical literature, we are left to assume that anything less will produce unacceptable numbers of risk free individuals testing HIV positive. One experiment conducted by Dr Roberto Giraldo at Cornell Medical University in New York seems to confirm this: When Giraldo ran HIV ELISAs on straight serum from confirmed HIV negative samples he found that all HIV negatives test HIV positive when their blood is undiluted!

Given all you know about the tests, I can understand your frustration at facing the prospect of testing to please your new partner. But if the girl of your dreams insists on a test, your options are pretty limited: Say no, say yes, or share the information youíve found on HIV testing and hope she might grant you a reprieve.

Good luck,

Christine

HIV Antibody Test Certificate of Accuracy

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References

to Questioning The Test FAQ's - If I Were to Test Positive?

to T Cells and Viral Load