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Author Topic: Routine Testing and the New CDC Guidelines  (Read 2771 times)

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Offline Ann

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Routine Testing and the New CDC Guidelines
« on: September 22, 2006, 12:25:18 PM »

The CDC has recently revised a portion of their guidelines to say that everyone should be having regular hiv screening, regardless of what perceived risk category they happen to fall into. This is in line with what we have been telling people for some time now - if you're sexually active, regular, routine sexual health screening is a must.

Please have a read through the AIDSmeds news article on the new CDC guidelines

Happy screening! :)

Ann
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Andy Velez

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Re: Routine Testing and the New CDC Guidelines
« Reply #1 on: September 22, 2006, 02:02:14 PM »
Dear All,

It will take some time to see how effective these new, suggested guidelines will be in addressing the very serious need for routine HIV testing. There are laws within a number of states which will have to be ammended if these guidelines are to be implemented.

So while bearing this in mind it's also important to remember that these guidelines in no way change what we know about how HIV is transmitted nor do they change the basics of safer sex and what is and what isn't risky.

These are two separate but related and very important aspects of dealing with the HIV epidemic.

Cheers,   
Andy Velez

Offline shouldaknownbetter

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Re: Routine Testing and the New CDC Guidelines
« Reply #2 on: September 22, 2006, 03:29:08 PM »
Ann;
I just read the revised guideline, and it appears the CDC is acknowledging the use of viral load testing as part of the diagnostic process.  Is this a new change from before?


Offline Ann

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Re: Routine Testing and the New CDC Guidelines
« Reply #3 on: September 22, 2006, 04:14:24 PM »
shoulda,

This has nothing to do with the types of tests used. I don't know what document you've been reading, but the revised CDC guidelines do not mention viral load testing at all.

Besides, it's the FDA that approves tests for diagnostic purposes, not the CDC.

PCR viral load testing is not approved for diagnostic purposes and I can't see that changing. Ever.

Ann
Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline shouldaknownbetter

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Re: Routine Testing and the New CDC Guidelines
« Reply #4 on: September 22, 2006, 06:31:17 PM »
Ann;

Here is the exact verbage from the guideline:

"Diagnostic Testing for HIV Infection

All patients with signs or symptoms consistent with HIV infection or an opportunistic illness characteristic of AIDS should be tested for HIV.
Clinicians should maintain a high level of suspicion for acute HIV infection in all patients who have a compatible clinical syndrome and who report recent high-risk behavior. When acute retroviral syndrome is a possibility, a plasma RNA test should be used in conjunction with an HIV antibody test to diagnose acute HIV infection (96).
Patients or persons responsible for the patient's care should be notified orally that testing is planned, advised of the indication for testing and the implications of positive and negative test results, and offered an opportunity to ask questions and to decline testing. With such notification, the patient's general consent for medical care is considered sufficient for diagnostic HIV testing."

Is a plasma RNA test a viral load test?

Offline Ann

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Re: Routine Testing and the New CDC Guidelines
« Reply #5 on: September 22, 2006, 07:02:17 PM »
shoulda,

Sorry, I missed that - I searched for viral load and PCR.

You'll note that it states a plasma RNA test should be used in conjunction with an HIV antibody test . Do you see where it says in CONJUNCTION with? This is because any type of viral load testing IS NOT APPROVED  for diagnostic purposes and a positive viral load test means absolutely nothing unless and until it is confirmed by antibody testing.

This procedure is nothing new. Viral load testing is still not approved for diagnostic purposes, nor will it be.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline shouldaknownbetter

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Re: Routine Testing and the New CDC Guidelines
« Reply #6 on: September 22, 2006, 09:51:18 PM »
Ann;

I see that; that is why I stated "as part of the diagnostic process."

It appears it is ok as a diagnostic tool when used with an antibody test.  Is this a new change by the CDC?

Offline Ann

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Re: Routine Testing and the New CDC Guidelines
« Reply #7 on: September 23, 2006, 05:34:10 AM »
shoulda,

As I said, this procedure is nothing new and I'll give you an example of when it MIGHT be used.

A person is brought into the ER with an extreme illness. A very high fever of over 104F. In all over terrible body pain. Can't walk, can't stand, even sitting or lying down is painful. Bacterial tests and other general tests show nothing. Patient is questioned further and it's revealed that they've recently been the receptive partner in unprotected intercourse with a person of unknown hiv status. In THIS case, a doctor MIGHT order a viral load test, along with an ELISA. If this person is truly suffering from hiv seroconversion illness, the viral load will likely come back off the chart.

In someone who has had no risk or a negligible risk, or even a high risk but has not been infected, if they go and have a viral load test done, they run the risk of having a false positive result. False positive results typically involve small numbers and not the very high numbers seen in primary infection.

However, try convincing a person who is already freaked out about hiv infection that their result is most likely false. They end up not believing their negative antibody tests. It starts a downward spiral into being a worried well. THIS is why the tests are not approved, and will not BE approved, for diagnostic purposes. They are only used in very few instances where it's already a good bet that the patient is indeed positive, but no matter what the result, it still MUST be confirmed with antibody testing.

By the way, we've seen several people in this forum ride the decent into worried well hell after getting a false positive viral load test. It ain't pretty.

THE ONLY NEW THING ABOUT THE CDC GUIDELINES IS THE RECOMMENDATION FOR ROUTINE SCREENING OF EVERYONE. The information about testing is only for background purposes.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Tim Horn

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Re: Routine Testing and the New CDC Guidelines
« Reply #8 on: September 23, 2006, 08:16:01 AM »
Shoulda:

Ann's explanation of what's written in the new CDC guidelines regarding plasma RNA testing is spot on.  Actually, I find this to be the most important line of text in the paragraph you cite:

Clinicians should maintain a high level of suspicion for acute HIV infection in all patients who have a compatible clinical syndrome and who report recent high-risk behavior.

The fact of the matter is, we get a lot of people who come to the Forums swearing that whatever symptoms they're experiencing are indicators of acute HIV infection.  When we press further for details, we find out that the behaviors/activities the overwhelming majority engaged in aren't high-risk (often not by a long shot).  Like Ann said, we do counsel plasma RNA testing (viral load) for people who may (or may not) have symptoms and have reported a high-risk situation. 

Of course, anyone who comes to the Forums and is convinced they are experiencing acute HIV infection is entitled to visit their healthcare providers and request plasma RNA testing.  But it's important to recognize that plasma RNA testing is expensive and is associated with a relatively high false-positive rate (hence the recommendation that it be used in conjunction with standard antibody testing). 

The most important aspect of the new guidelines, I believe, is that they are trying to "medicalize" HIV testing.  It's sometimes frustrating for us at AIDSmeds.com to deal with so many people crippled by fear and/or denial when it comes to HIV testing... to the point that they'd much rather guess that they're HIV positive than do what everyone should do when they have a medical concern -- see a doctor.  Hopefully the new guidelines, with their goal of making routine testing a routine part of medical care, will help rectify this. 

Tim Horn   
« Last Edit: September 23, 2006, 08:17:47 AM by Tim Horn »

Offline shouldaknownbetter

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Re: Routine Testing and the New CDC Guidelines
« Reply #9 on: September 23, 2006, 01:45:30 PM »
Hey, I totally agree with what both of you are saying; what I find interesting in this guideline is that the CDC is saying nothing about a "window" period.  They seem to be inferring a diagnosis by implementing these 2 tests involving potential ARS.  They do state something regarding "implications of a positive or negative result" And then right after that, imply that it is a diagnostic HIV test.  In fact, the subject matter of the paragraph is: Diagnostic Testing for HIV Infection

Of the 40,000 persons who acquire HIV infection each year, an estimated 40%--90% will experience symptoms of acute HIV infection (94--96), and a substantial number will seek medical care. However, acute HIV infection often is not recognized by primary care clinicians because the symptoms resemble those of influenza, infectious mononucleosis, and other viral illnesses (97). Acute HIV infection can be diagnosed by detecting HIV RNA in plasma from persons with a negative or indeterminate HIV antibody test.

Online RapidRod

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Re: Routine Testing and the New CDC Guidelines
« Reply #10 on: September 23, 2006, 02:34:06 PM »
When acute retroviral syndrome is a possibility, a plasma RNA test should be used in conjunction with an HIV antibody test to diagnose acute HIV infection (96).

Please, if you are going to quote, thoroughly quote what it says. As you can see not much has changed in what AidsMed advises.

Offline shouldaknownbetter

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Re: Routine Testing and the New CDC Guidelines
« Reply #11 on: September 23, 2006, 02:54:08 PM »
Rapid;

Take a look again at reply #4.  I did quote it completely.


I just want to inquire that if one is diagnosed negative per these guidelines that are stated for ARS, does that rule out further testing?  I have no agenda here, just fact-finding.  Thank you.

Online RapidRod

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Re: Routine Testing and the New CDC Guidelines
« Reply #12 on: September 23, 2006, 03:07:44 PM »
. If an RNA screening is used, it has to be followed up with and ELISA test. So really what is the reason with taking an RNA screening except to try to get people to follow up with their testing and for people that possibly may be going through ARS.

Offline Ann

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Re: Routine Testing and the New CDC Guidelines
« Reply #13 on: September 23, 2006, 04:33:21 PM »
shoulda,

The viral load tests do not rule out a negative nor do they confirm a positive. They are a piece of the puzzle and not a complete answer in themselves. The only conclusive negative answer at this point in time is a negative antibody test at three months. Period. The only conclusive positive at this point in time is a positive ELISA followed up with a positive Western Blot, which can occur as early as 22 days and in most cases, by six weeks. Period.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

 


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