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Medical Forum / Diseases and Disorders / AIDS / March 2005

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Western Blot to confirm ELISA not to be used as diagnosis

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George DeCarlo - 07 Mar 2005 16:31 GMT
HIV-1 Western Blot Kit
Epitope, Inc. Product Number 72827
PN201-3039 Revision #8
"SUMMARY AND EXPLANATION OF THE TEST

A sample that is reactive in both the EIA screening test and the
Western blot is presumed to be positive for antibody to HIV-1,
indicating infection with this virus except in situations of passively
acquired antibody or experimental vaccination."

"LIMITATIONS OF THE PROCEDURE

1. The assay must be performed in strict accordance with these
instructions to obtain accurate, reproducible results.

2. Although a Positive result may indicate infection with the HIV-1
virus, a diagnosis of Acquired Immunodeficiency Syndrome (AIDS) can be
made only if an individual meets the case definition of AIDS
established by the Centers for Disease Control. A repeat test on an
independent sample should be considered to control for sample mix-up or
operator error, and to verify a positive test result.

3. Individuals with HIV-1 infection may present incomplete patterns due
to the natural history of AIDS or other immunodeficiency states, e.g.:

a. AIDS patients may lose antibody reactions to p24 & p31;

b. Infants born to HIV-1 infected mothers, but who are uninfected, may
display incomplete patterns as passively acquired maternal antibodies
begin to disappear ;

c. Individuals who have recently seroconverted may display incomplete
band patterns;

d. Infected patients with malignancies and individuals receiving
immunosuppressive drugs may fail to develop a Positive result;

e. Individuals infected with HTLV-I/II or HIV-2, may exhibit incomplete
cross-reactivity;

f. Individuals may develop incomplete patterns that reflect the
composition of experimental HIV sub-unit vacines that they may have
received.

[...]

5. Since reactivity of any degree with any of the virus-specific
proteins identified on the strip is possible evidence of antibodies to
HIV-1, all samples interpreted as Indeterminate should be repeated
using the original specimen. In addition, it is recommended that
samples interpreted as Indeterminate be retested after six months,
using a fresh specimen.

6. Do not use this kit as the sole basis of diagnosis of HIV-1
infection. 7. A Negative result does not exclude the possibility of
HIV-1 infection. Antibody testing should not be used in lieu of donor
self-exclusion by blood collection establishments."

Sensitivity and Specificity

Sensitivity and specificity of the HIV-1 Western Blot Kit was
determined in comparative studies with a previously licenced HIV-1
Western blot using EIA repeatedly reactive samples from high AIDS risk
and low risk populations respectively."*

"INTERFERING FACTORS AND SUBSTANCES

Testing was performed on specimens from individuals with clinical
conditions unrelated to HIV-1 which might result in a reactivity with
proteins present. Samples studied included 25 from persons with auto
immune diseases, 12 with elevated gammaglobulins, 110 with viral
infections unrelated to HIV-1 and 38 other conditions. The viral
infections included samples positive in clinical tests for
Cytomegalovirus (12), Infectious mononucleosis (10), Epstein-Barr virus
(3), Rubells (12), Varcella-Zoster (3), Herpes Simplex (12), HBsAg (7),
and HTLV-1 (39). Although bands were occasionally present at viral
locations, none of the strips could be interpreted as positive."**

COMMENTARY:

* Although the Western Blot is supposed to be a "more specific" test to
confirm the results of the EIA (ELISA), the specificity and sensitivity
are assumed by the same indirect means. No gold standard was applied,
such as isolating HIV-1 from fresh patient plasma, in any of these
studies. These studies confuse specificity with a high reproducibility
of EIA by Western Blot.

** The samples studied to establish whether false positives resulted
from interfering factors appear to represent individuals with isolated
incidents of these factors. Even so, 38% had reactions on one or more
"viral" bands of the Western Blot. People at risk for AIDS typically
have accumulated many of these factors. One would assume that this
would lead to higher reactivity on the Western Blot. This presents a
catch 22 situation: these factors may be the cause of AIDS-like
syndromes but are considered HIV-1 related because the patients react
positive on EIA and Western Blot tests.
Alex - 07 Mar 2005 18:36 GMT
> HIV-1 Western Blot Kit
> Epitope, Inc. Product Number 72827
> PN201-3039 Revision #8
> "SUMMARY AND EXPLANATION OF THE TEST

> Sensitivity and Specificity
>
> Sensitivity and specificity of the HIV-1 Western Blot Kit was
> determined in comparative studies with a previously licenced HIV-1
> Western blot using EIA repeatedly reactive samples from high AIDS risk
> and low risk populations respectively."*

In other words, this Western Blot was not tested against
ISOLATION of HIV from positive samples.

Which is really all you need to know about these tests.
It is the same old story over and over again.

You know - dissidents and anyone else could make a lot
of headway by seeing to what extent HIV can be isolated
from blood samples that test positive on any of these tests.
(And by "isolate", I mean the orthodox methods of virus
isolation from blood.)

Alex
PaulKing - 19 Mar 2005 09:58 GMT
AS OF 1999, IT WOULD SEEM THE ROCHE AMIPLICOR HIV-1
MONITOR TEST IS THE MOST POPULAR PCR "VIRAL LOAD" TEST.

"The Roche Amplicor HIV-1 Monitor(TM) test kit,  approved by the FDA, was
used by more than 70% of  the laboratories reporting results."

http://www.phppo.cdc.gov/MPEP/pdf/rna/9902rnaa.pdf

The test kit list: http://www.fda.gov/cber/products/testkits.htm 

AMPLICOR HIV-1 MONITOR(TM) TEST

"The AMPLICOR HIV-1 MONITOR Test is not intended to be used  as a
screening test for HIV or as a diagnostic test to confirm
the presence of HIV infection."

http://www.fda.gov/cber/pma/p9500054.htm
http://www.fda.gov/cber/PMAlabel/P9500054LB.pdf 

NucliSens(R) HIV-1 QT -- HIV QT Nov. 13, 2001

"The NucliSens(R) HIV-1 QT assay is not intended to  be used as a
screening test for HIV-1 nor is it to  be used as a diagnostic test to
confirm the presence  of HIV-1 infection."
http://www.fda.gov/cber/pma/p0100010.htm
http://www.fda.gov/cber/pmalabel/P0100010LB.pdf 

COBAS AmpliScreen HIV-1 Test, version 1.5
Approval Date: 12/19/2003

"This test is not intended for use as an aid in diagnosis."

http://www.fda.gov/cber/products/hiv1roc121903.htm
http://www.fda.gov/cber/label/hiv1roc121903LB.pdf 

Procleix(R) HIV-1/HCV Assay -- IN0076-01, Rev. A
Approval Date: 6/4/2004

"The Procleix HIV-1 Discriminatory Assay may be used as an  aid in the
diagnosis of HIV-1 infection." 

http://www.fda.gov/cber/products/hivhcvgen060404.htm
http://www.fda.gov/cber/label/hivhcvgen060404LB.pdf

GENETIC SYSTEMS (TM) rLAV EIA

"The rLAV EIA is intended to be used as a screening test for  donated
blood or plasma and as an aid in the diagnosis of  infection with HIV-1."

http://www.fda.gov/cber/products/hiv1gen062998.htm
http://www.fda.gov/cber/sba/hiv1gen062998S.pdf

VIRONOSTIKAT(R) HIV-1 PLUS O MICROELISA SYSTEM

"System is intended for use as an aid in diagnosis of  infection with
HIV-1. It is not intended for use in  screening blood donors."

http://www.fda.gov/cber/pma/P020066.htm
http://www.fda.gov/cber/pmalabel/P020066LB.pdf

THE CAMBRIDGE BIOTECH HIV-1 WESTERN BLOT KIT

"Accurate diagnosis of HIV-1 infection is important  in determining an
individual's risk for  developing AIDS. Accuracy is complicated by
false-positive and false-negative (EIA) results. It  would appear that in
some limited infections, a  compartmentalized response occurs in which
expression of HIV-1 or its respective Immune  response is limited to a
restricted number of organs  and tissues.(17)"

"Slight ambiguities exist in the designation of the  molecular weights of
the HIV-I antigens. The designations  listed in Figure 1 have been
established by both internal  testing with known markers and consensus of
published
literature.(5-10)"

"Although a blot POSITIVE for antibodies to HIV-1  indicates infection
with the virus..."
"POSITIVE blot results using any specimen type  (serum, plasma, or urine)
should be followed with  additional testing. Such testing may rely on
alternative test methods or specimen types. The  clinical implications of
antibodies to HIV-1 in an  asymptomatic person are not known."

"The sensitivity ... using urine was evaluated by  comparing the urine
results to the results obtained  from testing paired serum specimens
collected from  individuals who were HIV-1 seropositive and from
individuals clinically diagnosed as AIDS patients."

http://www.fda.gov/cber/products/hiv1cam052898.htm
http://www.fda.gov/cber/label/hiv1cam052898Lb.pdf 

OraSure(R) HIV-1 Western Blot Kit

"The OraSure HIV-l Western Blot Kit is an in vitro  qualitative assay for
the detection of antibodies to  individual proteins of the Human
Immunodeficiency  Virus Type 1 (HIV-l) in human oral fluid specimens
obtained with the OraSure HIV-l Oral Specimen  Collection Device.

The OraSure HIV-l Western Blot Kit is not intended  for use with blood,
serum/plasma or urine specimens,  or for screening or reinstating
potential blood donors."
http://www.fda.gov/cber/pma/P950004.htm
http://www.fda.gov/cber/pmalabel/P950004Lb.pdf 

Reveal(TM) Rapid HIV -1 Antibody Test
"The Reveal" Rapid HIV -1 Antibody Test is intended for  use as a
point-of-care test to aid in the diagnosis of  infection with HIV -1. This
test is suitable for use in  multi-test algorithms designed for
statistical validation of rapid HIV test results."

http://www.fda.gov/cber/pma/p000023.htm
http://www.fda.gov/cber/pmalabel/P000023LB.pdf
Bennett - 19 Mar 2005 17:05 GMT
Or you could try reading the following papers, which DO isolate HIV
from 100% of AIDS patients and 0% of HIV-seronegatives.  Kinda in
support of the tests.

Cheers

Bennett

1. Jackson et al J Clinical Mole Bio 1988 pp1418-1418 "Rapid and
sensitive viral culture method for human immunodeficiency virus type
1."

2. Jackson et al J Clinical Mole Bio 1990 pp 16-19 "Human
immunodeficiency virus type 1 detected in all seropositive symptomatic
and asymptomatic individuals."

3. Ho et al NEJM 1989 321:pp 1621-1625 "Quantitation of human
immunodeficiency virus type 1 in the blood of infected persons."
PaulKing - 21 Mar 2005 07:19 GMT
Seventeen year old studies that have long ago been discreadited.

Sad attempt at a rebuttal.
GMCarter - 21 Mar 2005 11:47 GMT
>Seventeen year old studies that have long ago been discreadited.

LOL. By whom? How?
Bennett - 22 Mar 2005 04:22 GMT
LOL!  More like ignored.  The best rebuttal I've seen to these studies
is:

"I don't believe in PCR", courtesy of Jason Nusbaum.  Made me laugh
anyway.

When idiots like the Perth Group say things like "HIV cannot be found
in peripheral blood" I find it amusing to quote articles that can seed
several THOUSAND cultures from every cc of whole blood.  To claim
otherwise is simply lying.

Cheers

Bennett
PaulKing - 21 Mar 2005 07:16 GMT
REPOST FROM BELOW

HIV-1 Western Blot Kit
Epitope, Inc. Product Number 72827
PN201-3039 Revision #8
"SUMMARY AND EXPLANATION OF THE TEST

A sample that is reactive in both the EIA screening test and the
Western blot is presumed to be positive for antibody to HIV-1,
indicating infection with this virus except in situations of passively
acquired antibody or experimental vaccination."

"LIMITATIONS OF THE PROCEDURE

1. The assay must be performed in strict accordance with these
instructions to obtain accurate, reproducible results.

2. Although a Positive result may indicate infection with the HIV-1
virus, a diagnosis of Acquired Immunodeficiency Syndrome (AIDS) can be
made only if an individual meets the case definition of AIDS
established by the Centers for Disease Control. A repeat test on an
independent sample should be considered to control for sample mix-up or
operator error, and to verify a positive test result.

3. Individuals with HIV-1 infection may present incomplete patterns due
to the natural history of AIDS or other immunodeficiency states, e.g.:

a. AIDS patients may lose antibody reactions to p24 & p31;

b. Infants born to HIV-1 infected mothers, but who are uninfected, may
display incomplete patterns as passively acquired maternal antibodies
begin to disappear ;

c. Individuals who have recently seroconverted may display incomplete
band patterns;

d. Infected patients with malignancies and individuals receiving
immunosuppressive drugs may fail to develop a Positive result;

e. Individuals infected with HTLV-I/II or HIV-2, may exhibit incomplete
cross-reactivity;

f. Individuals may develop incomplete patterns that reflect the
composition of experimental HIV sub-unit vacines that they may have
received.

[...]

5. Since reactivity of any degree with any of the virus-specific
proteins identified on the strip is possible evidence of antibodies to
HIV-1, all samples interpreted as Indeterminate should be repeated
using the original specimen. In addition, it is recommended that
samples interpreted as Indeterminate be retested after six months,
using a fresh specimen.

6. Do not use this kit as the sole basis of diagnosis of HIV-1
infection. 7. A Negative result does not exclude the possibility of
HIV-1 infection. Antibody testing should not be used in lieu of donor
self-exclusion by blood collection establishments."

Sensitivity and Specificity

Sensitivity and specificity of the HIV-1 Western Blot Kit was
determined in comparative studies with a previously licenced HIV-1
Western blot using EIA repeatedly reactive samples from high AIDS risk
and low risk populations respectively."*

"INTERFERING FACTORS AND SUBSTANCES

Testing was performed on specimens from individuals with clinical
conditions unrelated to HIV-1 which might result in a reactivity with
proteins present. Samples studied included 25 from persons with auto
immune diseases, 12 with elevated gammaglobulins, 110 with viral
infections unrelated to HIV-1 and 38 other conditions. The viral
infections included samples positive in clinical tests for
Cytomegalovirus (12), Infectious mononucleosis (10), Epstein-Barr virus
(3), Rubells (12), Varcella-Zoster (3), Herpes Simplex (12), HBsAg (7),
and HTLV-1 (39). Although bands were occasionally present at viral
locations, none of the strips could be interpreted as positive."**

COMMENTARY:

* Although the Western Blot is supposed to be a "more specific" test to
confirm the results of the EIA (ELISA), the specificity and sensitivity
are assumed by the same indirect means. No gold standard was applied,
such as isolating HIV-1 from fresh patient plasma, in any of these
studies. These studies confuse specificity with a high reproducibility
of EIA by Western Blot.

** The samples studied to establish whether false positives resulted
from interfering factors appear to represent individuals with isolated
incidents of these factors. Even so, 38% had reactions on one or more
"viral" bands of the Western Blot. People at risk for AIDS typically
have accumulated many of these factors. One would assume that this
would lead to higher reactivity on the Western Blot. This presents a
catch 22 situation: these factors may be the cause of AIDS-like
syndromes but are considered HIV-1 related because the patients react
positive on EIA and Western Blot tests.
 
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