NYT: U.S. Weighs Whether to Open Era of Rapid HIV Detection in the Home

[DeepModem Mom]

U.S. Weighs Whether to Open an Era of Rapid H.I.V. Detection in the Home
By JOHN LELAND
Published: November 5, 2005


....Before the rapid H.I.V. tests were approved for professional use in 2002 and 2004, most federal programs concentrated on changing the behavior of people who were not infected.

But the availability of the rapid tests moved the Centers for Disease Control and Prevention to direct more efforts at the relatively smaller number of people who are already infected, identifying them before they can infect others, and in time for treatment to be most effective, said Dr. Ronald Valdiserri, acting director at the National Center for H.I.V., S.T.D. and TB Prevention.

On Thursday, the Food and Drug Administration's Blood Products Advisory Committee heard testimony on whether to recommend over-the-counter sales of the rapid test for home use. The agency approved a home testing kit in 1996, but users have to mail a blood sample to a laboratory and wait for results by telephone.

Proponents say rapid testing in the home will reduce the stigma and other obstacles that prevent many people, including one in four of the nearly one million Americans who are infected with H.I.V., from getting tested and starting treatment. Research shows that people who learn they are infected are less likely to infect others.

But many AIDS professionals, including those at the Bebashi clinic in North Philadelphia, have opposed home testing because they believe that people like Ms. Brown need education and counseling along with their results....


http://www.nytimes.com/2005/11/05/health/05aids.html

[Warren Stupidity]

1. Oh horrors! Safer sex!

Can't have that.

:sarcasm:

[kestrel91316]

3. And can't have people finding out their HIV status without

paying some doctor and some lab an arm and a leg............

[Liberal Veteran]

4. That isn't exactly accurate, you know.

1) An HIV test given by a private doctor generally costs the patient between 20 to 50 dollars (which generally includes a blood draw, ELISA test, and a follow up Western Blot if the test is positive to confirm the results). That's hardly an arm and a leg.

2) You can get tested for free at nearly any health department in the country.

I would agree that it may be more convenient to test oneself at home, but let's not pretend people don't get tested because it's so expensive, because it isn't and most public health clinics have had free anononymous testing for since 1987.

[Warren Stupidity]

8. Ok so for some it isn't cost.

Perhaps it is embarrassment, or fear of being outed or fear of having a big '+' sign painted on their back. Some of those people will use a home kit. Some of those people will get treated before it is too late. Some of those people will start to use condoms where before they didn't. This will save lives.

[psychopomp]

13. That's right

I was tested anonymously, for free, at my local Planned Parenthood office years ago. I assume they are still offering that service. Here in Japan I paid for the test at a local hospital though there are anonymous, free facilities here, also. It cost me about eighty dollars.

Unfortunately, I believe it is rare for patients to request the test at all here despite the fact that the rate of HIV infection is still rising in Japan.

[Liberal Veteran]

5. And one other thing....

As I stated in another post, there is a LOT to be said for getting tested in a place that is prepared to guide you if you are unfortunate enough to get a positive test.

When I got my positive test, the woman at the health department that gave me results took the time to explain the implications of a positive test and put me in direct contact with one of the 3 doctors in my town that have any experience treating HIV infection. Also, though it wasn't necessary in my particular case, the Health department was more than willing to perform contact services to anyone that might have been in danger of being infected without using my name.

As I said, I am not totally against a home HIV test, but there is something to be said for having someone with experience, training, and local knowledge of health resources onhand if the results are positive.

[Demoiselle]

11. You make sense, LV

To find a positive test result while home alone may be great for privacy...but I'd worry a lot about the most fragile among us who might go off the deep end right then and there.
I'd opt for a friendly, professional hand to hold, I think.

[Liberal Veteran]

2. I'm kinda ambivalent.

On one hand, I would absolutely LOVE to be able to go to one of the HIV information websites without having to dig through 18 zillion posts like: "My girlfriend and I were kissing last month and two weeks later I had a really bad flu. Do you think I have AIDS?"

You wouldn't believe how fucking obsessed some people convinced they have HIV from the most casual activities imaginable. They even get tested and still don't believe it when the test is negative.

I hate to sound self-centered, but as a person with AIDS, I grow really impatient with people who have HIV-obsession to the point that they have had 18 HIV tests all come back negative and are still convinced they might HIV. (And I am not exaggerating in the slightest, believe me.)

And yes, it would be convenient for some people.

But I can completely understand the concerns that a person without a counselor right there when a test comes back positive would do something rash. It is devastating to be told you have HIV, but many people don't realize that it is not necessarily a death sentence anymore. It IS very serious, but treatment has come a long way and yet still a lot of people would think it would mean they were going to die very soon. I've live with HIV for about 20 years now and six of those years with full-blown AIDS, but I haven't been hospitalized even once since my diagnosis. It's a frightening thing, but perhaps not as frightening as some people think and I could easily see someone taking a gun to their head the moment they get a positive result.

[DeepModem Mom]

14. Thank you so much for adding your personal experience and knowledge...

to this thread, Liberal Veteran.

[keopeli]

6. Thanks for reminding everyone that free testing is widely available, LV

[Maraya1969]

7. It is all bullshit. The AIDS drugs manufacturers are looking for another

market. The only sure way to prove the existence of a virus is to do a culture. A person suspected of TB has to had THREE cultures done in order to prove active infection.

Whatever caused the false positive on the first test can cause false positives on the next 20 tests.

I'm gonna get flamed.

[Warren Stupidity]

9. So perhaps the victims of false positives will head off

to their doctor and get more accurate testing?

I'm sorry but I really don't see the downside of this. The best those opposed can come up with is 'its a conspiracy to enrich the pharmcos' or 'the positives will off themselves' and I don't buy into either.

[Maraya1969]

12. I do not believe there is a conspiracy regarding this. And that

is all I am going to say.

[Liberal Veteran]

10. ROTFLMAO....That's not quite how it works.

It's not like you get a positive test and BAM! you are given a prescription for antivirals.

The guidelines for initiating HAART (highly active anti-retroviral therapy) aren't dependent on a positive test.

Following a positive test, a doctor will do a physical, a CBC, a viral load test, and t-cell count.

HAART is initiated when a person's t-cell count drops below. Generally speaking as long you maintain a viral load less than 100,000 and a CD4 count greater than 350, the doctor will not prescribe antivirals. He will advise you repeat the tests twice a year. If your t-cell count drops below 350 but above 200, the doctor will discuss whether or not to begin HAART. If your CD4 count drops below 200, then treatment guidelines dictate starting HAART.

In my own case, I presented with esophageal candiasis, pneumonia, weighed 110 pounds, a viral load of 250,000 and a CD4 count of 22.

Over the six years I have been on HAART, I've maintained an undetectable viral load (which doesn't mean the virus is gone, it means that in a single ml of my blood, the amount of detectable HIV is under the threshold of the test which is generally <50 copies per ml) and my CD4 count has risen (albeit very slowly, especially the first two years) from 22 CD4 (which put me at high risk for for just about any opportunistic infection that I encountered) to it's current level of around 350 which puts me at fairly low risk for opportunistic infection).

Generally speaking, the lower the CD4 count at time of diagnosis, the harder it is to climb up. It's not 100 percent true. Some people start HAART and their CD4 counts bounce back fairly rapidly into the 500's and higher, but for most patients, it takes a while. It took me almost a year to get a CD4 count higher than 100 and another year and a half after that to reach 200 where I could stop taking prophylaxis (septra which is a dirt cheap antibiotic to prevent PCP).


The point however is that not everyone with HIV is taking HAART. There are a lot of factors involved. Given that the average time from infection to full-blown AIDS (which is technically called advanced HIV-disease) is about 10 years, there is a fairly large percentage of people who are not currently taking antivirals. A very few will never have to. Some people are non-progressors who maintain a low viral load and normal cd4 count for as long as the tests have been done. Some people are slow progressors (I was). Most people with HIV will end up taking HAART as the disease progressively destroys the immune system to the point they reach the cutoff for needing treatment, but it's not a matter of some evil drug company plot.

I'll be the first to admit the drug companies gouge us for these drugs and that needs to be addressed, but doctors don't prescribe them because it makes money for BigPharma. They prescribe them because study after study and their own experiences with their patients show that the drugs (when used correctly) work.