Reprinted from The Times of India News Service, September 21, 2000
HIV Testing Questioned
By Rupa Chinai
“An HIV positive test usually means a ‘death
sentence.’ But AIDS counselors and doctors are finding that
a positive result is fraught with problems and can sometimes be
false. The validity of the HIV test hence needs re-examination,
Mumbai, India: An HIV positive test usually means a “death
sentence” for most patients. Over the past year however, AIDS
counselors and doctors in Mumbai are realizing that this need not
always be the case. They are finding that an HIV positive test result
is fraught with problems when it shows up in an asymptomatic person
who does not have the clinical symptoms of AIDS. This is because
the results can sometimes be false. The validity of the HIV test
hence needs re-examination, they say.
Also of concern are some unusual trends they are seeing, that do
not conform to what is the known picture of HIV\AIDS. Why, for instance,
are some people progressing into it faster than others? Why are
others remaining healthy even a decade after being diagnosed as
HIV positive? Are our public health messages giving information
that empowers people to take responsibility for themselves, or are
they whipping up unwarranted hysteria and fear?
Counseling and Allied Services for AIDS (CASA), a Mumbai based NGO
cites the instance of two women who experienced the havoc caused
by a false positive result - false, as it later turned out - when
they were subject to a mandatory HIV test during routine enrollment
in a hospital for child birth.
Shuttling from one hospital to another, faced with rejection, the
traumatized women ultimately delivered their babies. After birth,
the infants were administered a course of AZT, a highly toxic and
controversial anti-AIDS drug. The mothers were made to feel afraid
of handling their babies and feed them, for fear of passing on their
infection. In time, the women underwent a second HIV test, but this
time it turned out to be negative.
“Being HIV antibody positive does not mean being virus positive'',
insists Manu Kothari, professor of anatomy at Mumbai's KEM Hospital.
This view is also held by several Western scientists who say HIV
testing in Asia and Africa is fraught with problems. There are at
least 70 different pre-existing conditions - including malaria,
TB, malnutrition, fever, the common cold and even the condition
of pregnancy - that could cause cross-reactivity, leading to a false
HIV positive result. According to these scientists, the problem
arises because the HIV test is not specific for detection of the
virus. The literature accompanying the Eliza test kits (Abbott Laboratories
for instance) amply clarifies that the presence of antibodies does
not necessarily confirm the presence of the virus.
Alka Gogate, a microbiologist, and project director of the Mumbai
AIDS Society concedes that reliance on a single HIV test is not
acceptable in labeling a person as `HIV positive'. At least three
confirmatory tests are required to eliminate the possibility of
picking up other infection markers. Many private laboratories in
the city lack accreditation and technical expertise to assure standardized
testing, she says.
“The possibility of false results is true for any test - be
it hepatitis, typhoid or AIDS - where a small fraction of the results
are likely to be false. It is important that people know this. Ideally
the test should not be done when a person is suffering from high
fever or other infections. People have a right to reject mandatory
testing imposed by private hospitals. They should go for voluntary
HIV testing when their physician suspects they have symptomsindicative
of clinical AIDS'', Dr. Gogate says.
CASA and several other counseling groups meanwhile report that there
is strong evidence to show that the damage caused to the immune
system can be reversed with right nutrition, changed lifestyle,
a supportive family and good counseling. Experts concede that this
is “an accepted medical phenomenon''.
“We have seen so many cases of people who remain well despite
testing HIV positive since the past decade. Many of them even putting
on weight. There is need to empower people with this information
so that they can take control, rather than feeling helpless. We
have seen that it is making a difference, and this is not just hearsay'',
says Gayatri Titus, a counsellor at Conwest Jain Clinic and Harkisondas
Counselors are meanwhile bewildered by some trends seen, that do
not conform to the set pattern of infection transmission. Why for
instance, are they seeing “discordant couples” where
one partner is HIV positive and the other remains negative, despite
their failure to use condoms?
Western scientific literature has also noted this phenomenon and
raised the possibility of whether anal sex, in combination with
factors of antibiotic or recreational drug abuse, and nutritional
stress, could lead to the progression of AIDS. At least two Mumbai
studies point to the alarming progression of AIDS in the city's
gay community and amongst its migrant workers who are vulnerable
to homosexual practice. Could the practice of anal sex be a determinant
in the progression of AIDS amongst couples who practice anal sex?
According to Priyadarshini Roy, a researcher at CASA, there is need
to re-examine what is known, and a greater openness to accept that
what we are seeing calls for other explanations.