HIV and AIDS

The verdict of the Durban Declaration - signed by over 5,000 of the world's leading scientists, including eleven Nobel prizewinners - says:"The evidence that AIDS is caused by HIV is clear-cut, exhaustive, unambiguous and meets the very highest standards of modern science".

A very small group of people - some of whom purport to be scientists - repeatedly (and quite irresponsibly) question and deny the connection between HIV and AIDS - and therefore also the validity of current testing and treatment methods. Their arguments are baseless, rely entirely on pseudoscience and wholly ignore the overwhelming wealth of meticulous peer-reviewed scientific data in existence; which shows that acquired immune deficiency syndrome (AIDS) is the direct result of long-term damage to the immune system caused by infection with the human immunodeficiency virus (HIV).

It is also interesting to note that the majority of these so-called 'AIDS dissidents' still continue to deny the very existence of HIV itself - long after it has become possible to isolate and suppress the virus - and that their beliefs are therefore as preposterous as those held by people who claim that HIV only affects homosexual men and drug users, or that intercourse with a virgin will cure AIDS.

Almost without fail, the people who continue to make these ludicrous claims have an alternative extremist (religious, financial, moralistic, political or simply bigoted) agenda that is served by perpetuating the myths on which AIDS denialism are based.

Whilst it is true that the AIDS dissidents can count a Nobel Prize winner amongst their ranks, it is also worth bearing in mind that this same Nobel Prize winner (in his own book, 'Dancing Naked in the Mind Field') openly boasts about his use of LSD and his belief in astrology and having survived an extraterrestrial encounter (with a glowing raccoon).

It is also interesting to note that at least 19 prominent AIDS dissidents have died of AIDS-related complications after refusing treatment.

One of the most vocal of the above-described "baseless, preposterous, ludicrous, extremist, pseudoscience" people is Professor of Molecular and Cell Biology Peter Duesberg, winner of an Outstanding Investigator Grant from the National Institutes of Health before he published an article questioning the HIV/AIDS theory. Since that time he has been denied all grant money, though billions have been given to researchers who support the government's position.

Dr. Duesberg's questioning of the HIV/AIDS theory is based on his contention that AIDS doesn't follow the pattern of an infectious disease, and that it consists of a particular set of diseases that are known to be caused by repeated exposure to toxic chemicals. He says that no theory is needed to explain AIDS, since the diseases linked to AIDS are known to be caused by specific toxins, and that the increases in the numbers of cases of those diseases correspond to immediately previous increases in exposure to those toxins. He also says that the nature of viruses is such that they can't cause the pattern of disease that has been called the AIDS epidemic.

Anyone interested in examining the other side of the debate could visit Dr. Duesberg's web site at related link or read one of his books. His web site includes a PDF file called "$bn AIDS Quiz" that summarizes his case in just a few pages.

HIV ELISA/Western blot is a set of blood tests used to diagnose chronic infection with human immunodeficiency virus (HIV).

HIV testing

A blood sample is needed. For information on how this is done, see: Venipuncture.

No preparation is necessary.

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Testing for HIV infection is done for many reasons, including:

• Screening people who want to be tested
• Screening people in high-risk groups (men who have sex with men, injection drug users and their sexual partners, and commercial sex workers)
• Screening people with certain conditions and infections (such as Kaposi's sarcomaor Pneumocystis jirovecii pneumonia)
• Screening pregnant women to help prevent them from passing the virus to the baby
• When a patient has an unusual infection

A negative test result is normal. However, people with early HIV infection (termed acute HIV infection or primary HIV infection) often have a negative test result.

A positive result on the ELISA screening test does not necessarily mean that the person has HIV infection. Certain conditions may lead to a false positive result, such as Lyme disease, syphilis, and lupus.

A positive ELISA test is always followed by a Western blot test. A positive Western blot confirms an HIV infection. A negative Western blot test means the ELISA test was a false positive test. The Western blot test can also be unclear, in which case more testing is done.

Negative tests do not rule out HIV infection. There is a period of time (called the "window period") between HIV infection and the appearance of anti-HIV antibodies that can be measured.

If a person might have acute or primary HIV infection, and is in the "window period," a negative HIV ELISA and Western blot will not rule out HIV infection. More tests for HIV will need to be done.

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

People who are at high risk (men who have sex with men, injection drug users and their sexual partners, commercial sex workers) should be regularly tested for HIV.

If the health care provider suspects early acute HIV infection, other tests (such as HIV viral load) will be needed to confirm this diagnosis, because the HIV ELISA/Western blot test will often be negative during this window period.

Dewar R, Goldstein D, Maldarelli F. Diagnosis of human immunodeficiency virus infection. In: Mandell GL, Bennett GE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 119.

Sax PE, Walker BD. Immunopathogenesis of human immunodeficiency infection. In: Goldman L, Ausiello D, eds. Cecil Medicine.23rd ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 408.

Review Date: 06/09/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.