Re: False positive HIV report

[Guest guest]

This unfortunate episode brings out several issues that need to be addressed

urgently in HIV testing.

The quality of HIV testing in the country leaves much to be desired. One reason

is clearly the lack of awareness of proper guidelines for testing in both

government and private laboratories. Even in some medical college departments,

HIV positive reports are being given just after two tests. Testing guidelines,

preferably that of NACO which is quite detailed, should be made available to

every centre, government or private, where HIV testing is done for whatever

purpose. It is difficult to regulate private laboratories since no mechanism for

quality control exists at present. But the doctors who interpret the test

results should certainly check the test report to see whether the required tests

have been done.

Counseling is not given the importance it deserves. Most doctors are not aware

of the need for counseling in the case of patients who require HIV testing.

Often only a blood sample with a request for an HIV test is received by the

testing centre. In such cases, only the referring doctor can arrange the

counseling. In the case of private laboratories, where only a few HIV tests are

done daily, it is impossible to provide a counseling service.

It is doubtful whether a laboratory whose primary purpose is to provide

laboratory services can be compelled to provide counseling services. Very

often, people get tested in private laboratories or even send their blood to

collection centres to maintain their anonymity. This results in their not being

able to get advice from a health professional, about the test they should take,

and also undergo counseling. In this particular instance, the wrong test was

done initially. A test for HIV antibodies performed just 4 days after a risky

exposure is not at all useful. This is one of the areas discussed with the

subject in the pre-test counseling.

It should be the duty of the doctor who orders a HIV test to also arrange

counseling and, if facilities are not available, do it himself.It is difficult

to understand how a reputed lab such as Ranbaxy SRL could have goofed up the

test results of two samples of the same person on two different tests. This may

have resulted from mislabeling, short circuiting of the test procedure by doing

only one instead of the mandatory three tests, or because of contamination in

the lab.

The lesson this incident holds for all of us is, that some form of external

quality control/accreditation should be in place, wherever HIV testing is done.

NACO is already implementing this in government institutions. Private

laboratories also should be encouraged to avail of this facility since the

private sector is taking on an increasing share of health care.

Dr.M.Prasanna Kumar

E-mail: mpkumar@...

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