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CDC nixes Western Blot HIV test

Subject:   CDC revises criteria for HIV “surveillance case definition.”
Appears to end requirement of “confirmatory” Western Blot,
and generally make it easier to add new “HIV” cases.
For the first time since 2008, the CDC has revised definitions of “HIV” and “AIDS” for the purpose of “surveillance case definition.”
Revised Surveillance Case Definition for HIV Infection — United States, 2014

Though the new guidelines are written in bureaucratic gobbledygook, it appears that–a least for counting cases–a Western Blot test is no longer required as the “confirmatory” test after an initial reactive ELISA or other first test, as noted in this sentence:

The most important update is revision of the laboratory criteria for a confirmed case, which addresses the development of new diagnostic testing algorithms that do not use the Western blot or immunofluorescence HIV antibody assays.

The second test just has to be different from the first, and apparently even a rapid test will do. From my reading, several changes make it at least a little easier to capture a “positive” for the CDC’s database.  Apparently, the number of new annual “cases” has flat-lined so much that our friends at the CDC need to beef up their case numbers to pretend there is still an “epidemic” of HIV-AIDS.
Perhaps those of you who know the alien language of bureaucratese better than I, can read it and share your thoughts, which I will compile and send to this same list.
Here’s the “Summary” of the report, which was in the CDC’s April 11, 2014 Morbidity and Mortality Weekly Report. (I added my emphasis in three sentences.)


Following extensive consultation and peer review, CDC and the Council of State and Territorial Epidemiologists have revised and combined the surveillance case definitions for human immunodeficiency virus (HIV) infection into a single case definition for persons of all ages (i.e., adults and adolescents aged 13 years and children aged <13 years). The revisions were made to address multiple issues, the most important of which was the need to adapt to recent changes in diagnostic criteria. Laboratory criteria for defining a confirmed case now accommodate new multitest algorithms, including criteria for differentiating between HIV-1 and HIV-2 infection and for recognizing early HIV infection. A confirmed case can be classified in one of five HIV infection stages (0, 1, 2, 3, or unknown); early infection, recognized by a negative HIV test within 6 months of HIV diagnosis, is classified as stage 0, and acquired immunodeficiency syndrome (AIDS) is classified as stage 3. Criteria for stage 3 have been simplified by eliminating the need to differentiate between definitive and presumptive diagnoses of opportunistic illnesses. Clinical (nonlaboratory) criteria for defining a case for surveillance purposes have been made more practical by eliminating the requirement for information about laboratory tests. The surveillance case definition is intended primarily for monitoring the HIV infection burden and planning for prevention and care on a population level, not as a basis for clinical decisions for individual patients. CDC and the Council of State and Territorial Epidemiologists recommend that all states and territories conduct case surveillance of HIV infection using this revised surveillance case definition.

The revisions also seem to make a few changes (see the end of the report) in the list of “opportunistic illnesses” (that old fashioned way of counting AIDS “cases,” in which the patient actually had to be ill.)

–Terry Michael

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