In one study (The Lancet, 1986; I: 1090-92) the amount of HIV antibody detected in ELISA tests was greatest immediately after blood transfusion and decreased between transfusions.
In another instance, (AIDS, 1988; 2: 405-6), a volunteer was given six injections of donated HIV negative blood at four day intervals. After the first injection his HIV test was negative, but the signal of a positive antibody response increased with each transfusion.
Once a patient is shown to be HIV positive, doctors persuade them of the importance of regularly testing their blood for abnormalities, particularly for a significant drop in the number of T-helper cells (CD4s), considered an indicator of the presence of major diseases associated with AIDS.
CD4 counts are practically meaningless as a measure of disease progression and can show a rise or a fall at any given point in the day. In many clinics throughout the world "significant" decline in CD4s is used as marker for future prophylactic drug treatment. Two hundred T-cells per millilitre of blood is considered the point at which the patient will be told that without drugs like AZT, ddI or Septrin, their chances of acquiring one of the diseases associated with AIDS, such as Pneumocystis carinii pneumonia (PCP), are fairly high.
Many studies have shown that the average T-cell count for a non HIV tested person can vary from as low as 200 up to 2,000. There are many instances of people with fewer than 50 T-cells who remain perfectly healthy. In a recent BBC "File on Four" documentary, Professor Ian Weller who coordinated the British arm of the Concorde AZT trial testing the drug on healthy HIV positive volunteers, commented: The thing we have to remember about CD4 (T-cell) counts is they are very variable. They can vary in an individual over the time of day . . . lower in the morning and higher in the evening. They can be affected by things that you do such as walking to the clinic, as opposed to riding a bike. . . . the amount of sunshine can affect them. Smoking as well."
Another variable which can seriously affect the outcome of CD4 testing is the sheer innaccuracy of laboratory process. For that same programme a volunteer elected to have blood taken for T-cell counting.
Two samples taken from the same vein at the same time with the same needle were sent to two different laboratories. The resulting CD4 counts varied by 33 per cent!
Once an otherwise healthy patient has tested HIV positive, has a low CD4 count and is exhibiting stress related problems, virtually all doctors working in the field reach for the prescription pad and offer prophylaxis.
The idea is to give the patient a drug on the assumption that this just in case medication will stop the disease before it starts. In the case of the main anti HIV drug AZT, this assumption was demolished with the recent publication in The Lancet of the Concorde Trial results, which showed that AZT was of no benefit to HIV positive individuals who remained asymptomatic (The Lancet, 9 April 1994).
Besides there being no rationale for their use, a patient with no symptoms given these drugs begins to exhibit all the problems associated with the side effects of the drugs side effects that bear an uncanny resemblance to the list of symptoms doctors describe in HIV infection or full blown AIDS.
A recent study concluded that prophylaxis with the antibiotic Septrin against PCP is far more likely to cause the patient to develop oral candidiasis, wasting symdrome, cytomegalovirus and M avium complex disease all commonly considered AIDS illnesses than in patients who don't take the drug (New Eng J of Med, 23 December 1993).