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Cattaneo et al report the interesting finding of human immunodeficiency virus (HIV) infection in individuals lacking risk behaviour.1 With any postmortem sample, serological false positivity is a well known phenomenon,2–3 and in the above instance in particular, confirmatory testing is important for confidence in test results. Although concordance in different screening assays is an excellent predictor for true positivity with any antemortem blood samples, the same may not be true for postmortem samples, where false positivity as a result of unsuitability of analyte can occur with more than one assay. When a single screening test is used, confirmation is especially important.
The authors reply
We thank Drs Barbara, Galea, and Warwick for their letter concerning our article on testing specimens from cadavers for markers of human immunodeficiency virus (HIV) and hepatitis C infection. The points they raise are all covered in the article, but are worth emphasising.
We are well aware that false positive serological reactions can occur with postmortem samples and commented on this in the discussion section; it was for this reason that data for hepatitis B serology were not included.
We agree that confirmation testing is especially important and were pleased with the concordance of the postmortem results for HIV testing between the enzyme linked immunosorbent assay (ELISA) and agglutination methods, and between the postmortem and (where known) antemortem findings.
Our article emphasises that in the subjects studied, lack of risk behaviour does not mean that there was necessarily no risk behaviour—just that it was not common knowledge and was unknown to the pathologist carrying out the necropsy.
The main point of our paper was that medico-legal practice deals with a particular and selected population that has a high prevalence of markers for HIV and hepatitis C infection, irrespective of known risk behaviour, and in many cases a rapid and easily performed screening test would give early warning of a potential problem.
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