$1 chip tests for HIV in 15 minutes, fits in your wallet | Hacker News Reader

$1 chip tests for HIV in 15 minutes, fits in your wallet

fastcompany.com

214 pointsd0ne124 comments

I really doubt the "no human interpretation" part of the Engadget article. I've been involved in HIV education as part of the gay community, and this sort of kit worries me greatly. If the test is an antibody based test, then it could do far more harm than good by giving uneducated users a false sense of security: a negative result does not mean that you don't have HIV.

While I'm sure that everyone on HN understands the seroconversion window period, this is simply not the case in the larger community. Ignorance about HIV is widespread. I cannot even begin to count the number of people who believe that pulling out before ejaculating affords some sort of magical protection from the virus. These are the same people who upon seeing a negative result would assume that they're safe without condoms.

The CDC states that the window period for detectable HIV antibody formation is three months; however, this figure is based on first generation HIV tests and is considered somewhat conservative. Public health experts like H. Hunter Handsfield state that detectable antibodies usually form in four to six weeks.

Whatever figure you choose to believe, it's a pretty significant time period. And it's a deadly one. It's during the window period that an HIV infected person is most infectious. Their viral loads are off the chart and they can unknowingly infect multiple people in a short period of time.

The "cure" for HIV is the same as it has always been: education and safer sex practices. HIV is largely a preventable disease. I would be okay with personal test kits if they were bundled with extremely clear educational packets printed in multiple languages. But this particular kit is advertised too much like a silver bullet to assure me that the manufacturers are anywhere near that responsible.

>> While I'm sure that everyone on HN understands the seroconversion window period...

I don't. Care to explain?

Usually, an HIV test doesn't test for presence of the virus itself; it tests for the antibodies your immune system develops in response to infection. The "window period" is the span of time between contracting the virus and the presence of detectable antibodies, which can be up to 6 months in some cases (though it's usually shorter). During this period, a person will test negative for HIV even though he or she is infected with the virus (and, worse, is contagious).

Newer tests have been developed that test for presence of the virus's RNA, shortening the window period to about 21 days (if I recall correctly), but they are more expensive and much, much less widespread.

thanks for the explanation. it worries me that anyone thinks this is common knowledge amongst a more-or-less programmer community. It worries me even more that perhaps it is, and I'm just ignorant.

Any time I see a comment like yours, the correct response to your question is almost always, "It's a system problem." If we aren't effectively disseminating knowledge about an important public health risk, we're not putting ourselves in a winning position.

This was taught in my school system, but not in such depth. They focused on prevention, rather than recognition, and we had to rely on old faithful Wikipedia to tell us the rest.

An additional piece of information- you're approximately 4,000% more likely to transmit HIV during this early stage infection because of this high viral load. Some research estimates as much as 50% of all new infections come from people in this early infectious window.

Whoa. I knew about the window, but NOT that it was much more contagious during the early window. Thank you!

Here is an excellent video that explain in detail this that in the early stages it is much more contagious http://www.ted.com/talks/elizabeth_pisani_sex_drugs_and_hiv_... and others IMPORTANT commonly unknow details that change totally how to fight to the virus.

I only learned about it the first time I got tested. If this is the case among most people, a self-test like this could be dangerous in that a lot of people who've never been tested would be likely to start using it. If I'm abnormal, though, I'm curious where most people know it from.

It's not good public health to deny information to everyone because some people will misuse said information.

While the linked rag's piece is sensationalized, the Nature Medicine article on this device is more useful. http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.2408....

I am not at all opposed to providing information! I merely want the test to come with very easy to understand instructions so that people know what results really mean.

> I merely want the test to come with very easy to understand instructions so that people know what results really mean.

Do you see any evidence that it will not?

Do you see any evidence that it will? I don't need evidence either way to state that I prefer for it to be distributed with such information. If it is, then that's great.

All I see is that this isn't in large-scale production yet (though chips do exist and have been verified to work), and likely won't be marketed to the general public. Preferring it to be distributed with information is great - I entirely agree with that - I'm just trying to point out that your reasons for expecting it not to include that ("this particular kit is advertised too much like a silver bullet to assure me that the manufacturers are anywhere near that responsible") make no bloody sense. This isn't advertising, this is a report on a study that was published in Nature (so why should we care what some reporter characterizes it as?), and there are no manufacturers yet.

I admit to having a knee-jerk reaction. The "no more condoms for me!" comments I saw on the original Engadget article evoked some very unpleasant memories. Having seen the effects of HIV on a first-hand basis, I sometimes fail to respond to such things with purely rational objectivity. I ask your pardon for that.

It actually is a public health issue. Officials often make decisions on what treatments are available to what groups based on their effects on public health. For instance, vaccination or lack there of of certain demographics, when to begin mammograms, etc.

These tests absolutely fall under the FDAs jurisdiction; after all, pregnancy tests do! If research was done that found that people would ignorantly use these tests in lieu of condoms, that would worsen the HIV epidemic considerably, and the FDA would likely not approve them for off the counter usage.

I'm libertarian minded, so my feelings about this are more complicated from that. But you brought up public health, and from a public health standpoint there absolutely is an interest in denying people access to technology that would worsen an epidemic!

When you frame the argument like that, there's no disagreeing. Keep in mind I wasn't advocating for technology that would worsen an epidemic, but I don't see that as a strawman; I see your point as orthogonal rather than in reply. I'm not saying that I would advocate for throwaway tests in public bathrooms with no support system around them. I'm looking at the device, not the silly article written about an article written about a Nature Medicine article.

Couldn't agree more (hence my post) - although nutrition may play a role in the antibody response. Malnourished individuals (especially those with low protein diets) tend to show slower antibody responses, so may have a longer seronconversion window period

"Researchers at Columbia University claim the mChip has a 100 percent detection rate, although there's a four to six percent chance of getting a false positive"

That sounds like a negative result DOES mean you don't have it, but a positive result DOESNT mean you do.

Edit: I guess this is just misleading and you actually can get false negatives.

A negative result DOES mean there are not detectable levels of antibodies. However, while obviously highly linked this is NOT the same as saying you don't have it.

They're correct to say it has a 100% detection rate (assuming it does, but we have no reason to suspect otherwise), but I think this is quite misleading - it's detecting HIV-specific antibodies, not the virus itself.

Wow. Yeah, that's pretty misleading. Hope they have a big warning label to go with it.

Better false positives than false negatives. Generally, after testing positive for HIV, there are follow-up tests done to verify the result (usually with a different test from the first) and to check for t-cell count (to determine how damaged the immune system is).

Does anyone here know anything about what goes into creating a test with a 0% false negative rate? That sounds impressive (even with the noted caveats that it's detecting the antibodies and not the virus).

Making a test with 0% false negative rate is a piece of cake:

if (test_taken == true) { test_result = true; }

No negatives means no false negatives. ;)

But seriously, this is the classic trade-off between high sensitivity (no false negatives) and high specificity (essentially no false positives). Usually, the lower you set your threshold for detection the more likely you are to tell some people they have the disease when they actually don't. Where you set that bar depends on what you're trying to accomplish and forces you consider the harms associated with telling people they have disease when they don't or missing disease in someone who does.

All this said, I think it's role is a not to be a "check if someone is clean for sexytime" test (incidentally, probably not a good tagline).

Instead, it's a cheap, easy and effective way to test people (especially pregnant women) so they can begin a medical regime, rather than not having any realistic means to test and risk further spread and health damage.

Your comment sounds like someone saying at the advent of the pill that it was not about enabling promiscuity but about allowing wives to manage their family planning better.

Thanks for playing this role on HN. I've responding to people on engadget to this effect; it really worries me that there are so many comments like "no more condoms for me!"

The irony is that such a technology could easily worse the epidemic in the U.S. because of such ignorance.

"HIV is largely a preventable disease."

Except when the government is responsible for spreading the disease. 50% of all new infections come from intravenous drug use, and an even larger percentage are secondary to drug users. If you're gay then it's not illegal to use condoms, but if you're a heroin user then you can literally get put in jail for trying to use clean needles.

What's more, many black communities in the US have higher HIV rates than sub-Saharan Africa. Why? Because so many black males are in prison that it completely changes the sexual dynamics for everyone left on the outside. And further, many of those in prison contract the virus and then end up spreading it throughout the larger community once they get released.

--------------- but if you're a heroin user then you can literally get put in jail for trying to use clean needles. ---------------

Many pharmacies have programs for drug users to buy clean needles, no-questions-asked for exactly this reason.

I am not negating what you said, I'm am sure there are elements of the program (or accessibility) that make it a less-than-perfect solution, but it does exist.

>Many pharmacies have programs for drug users to buy clean needles, no-questions-asked for exactly this reason.

unfortunately, not being a drug user i couldn't benefit from it. Once i needed to buy a syringe, and when i'd ask for it (it was here in Bay Area), they would make big eyes and refuse. Surprised, i tried a couple other places - the same. Until, at another place, they sold it to me and made sure that it packed so when i'm walking to the car, it wouldn't be visible.

Where I live in Canada we have clinics where people can get clean needles / properly dispose of used ones.

Vancouver (where I live right now) has several needle exchanges, as well as, safe injection sites.

I was reading yesterday that coastal health is releasing a free crack pipe + cleaner kit.

Granted we are likely a bit more progressive then the rest of the country.

Yeah, Gabor Mate is doing some awesome things with OnSite. There's actually a really good interview with him here:

http://www.wpr.org/book/100307a.cfm

>if you're a heroin user then you can literally get put in jail for trying to use clean needles.

// You know what's not illegal. Stopping injecting yourself with dirty needles.

Australia (and particularly NSW) has a long running and very successful needle exchange program. The anti exchange (largely conservative christian) lobby has been basically silenced by its undoubted effectiveness.

I don't think even the crazies here (Australia) bother lobbying against needle programs anymore.

Injecting rooms are a different story though...

You know what would be a fantastic sub-market for this? Bars and clubs in college towns. Regardless of whether you believe 1-nighters are moral or not, they're going to keep happening. Might as well promote safety and reduce the spread of STIs.

Edit: I don't mean this should be an alternative to traditional protection. It just adds another layer of certainty.

I speculate it would do more harm than good. Safe sex practices are important even if you have a means of lowering the risk of HIV.

It's a risk. But the same could be said for condoms in nightclubs.

Generally, the best public safety campaigns work are "defense in depth". You discourage sex in general, discourage unsafe sex, discourage casual sex, discourage polygamy, provide condoms, and encourage tests. It all generally works, as long as you don't treat any of it as a magic bullet.

It's the extremists who either think a) abstinence is the only protection; or b) causal sex is fine as long as you take precautions; who cause problems, as they tend to discourage defense in depth.

So ideally, they would have an ambiguously enthusiastic "Over 90% accurate!" blurb, and be packaged with a condom or two.

"causal sex is fine as long as you take precautions" is an "extremist" view?

Isn't this the same line of reasoning that the Catholic church uses to try to prevent the spread of condoms in certain parts of the World?

Do your research. At least three different companies produce and distribute a Vatican-approved condom under license. Its innovative latex-derivative material has been engineered under Church supervision to block the HIV virus while allowing sperm to pass unhindered.

UPDATE: Folks this is indeed one of the oldest jokes ever told. I’m not surprised nobody is laughing, my ability to tell a joke it matched only by my ability to compose rhyming couplets extemporaneously. But I am surprised nobody identified it as such.

> Its innovative latex-derivative material has been engineered under Church supervision to block the HIV virus while allowing sperm to pass unhindered.

This is either a joke or the stupidest thing I've heard all month.

Anyway, the RCC does allow people to use condoms when the primary purpose is disease control and not contraception.

http://www.telegraph.co.uk/news/religion/the-pope/8148899/Po...

This is either a joke or the stupidest thing I've heard all month.

Alas, this was a joke AND the stupidest thing you’ve heard all month. I will be more mindful of Poe’s Law (as suggested elsewhere) in the future.

You have my attention, but all I have is contrary:

http://www.lifesitenews.com/news/breaking-vatican-reaffirms-...

Do you have a reference?

While I realize that joking around is discouraged here, maybe it would be best if we didn't turn the humor detector all the way off.

I thought it was a hoot, anyway.

The problem is http://en.wikipedia.org/wiki/Poes_law. It's hard to get far enough beyond the actual nutjobs that we can tell you aren't one.

raganwald is usually pretty good about it [edit: meaning, of course, that I usually enjoy his posts], but this one was so close to the edge because of all the controversy last year that I thought I may have missed something.

My research overwhelmingly points to you being wrong. If you can provide some supporting references, I am happy to be corrected.

Subtle humor about the Vatican is just... not enough, in this day and age:

http://www.youtube.com/watch?v=hEn0px0uJZQ

DISCLAIMER: despite being both clever and serious, this link is very NSFW.

In answer to your query: Yes. It is the same logic the Catholic church uses to oppose the spread of traditional latex condoms, particularly in Africa.

Yes, but they don't require the same answer.

It's certainly possible that, when condoms are made widely available in a region, this will result in more people having sex. Likely, even. The Vatican's position is that this increase in people having sex outweighs the lower average chance of transmission.

This is empirically false. But it needn't be inherently. Suppose you offered people some other form of protection that decreased the chance of transmission of HIV by 90%, and for some reason in response to this people widely abandoned the use of the condom. This would increase the overall prevalence of HIV by a wide margin.

Take a model where this device decreases the chance of transmission of HIV by 0%, while making some decent sized chunk of people more likely to have unprotected sex because of a false sense of security.* In that case, passing this out at night clubs would likely significant increase HIV's prevalence.

I see a definite use for it, but more in the way of buying a 4 pack every year and not having to go to a clinic.

*I think this model is likely correct, given what we know about the epidemiology of HIV.

Except this does not test for all kinds of other STIs.

I really don't think that is a good idea. If people believe they won't get AIDS, which is the scariest STI, they'll be less likely to use protection, which will increase the spread of things like chlamydia (which has only minor side effects, like possible infertility) . Also, I bet the error rate goes up to a scary level once you have it being self-administered by drunk people.

As a recent college student, take your paternalism and shove it. I want this.

As a current university student, it's not my paternalism. It kind of sucks, doesn't it?

But it's like lots of things in life: sometimes we can't have nice things because other people, who are much less mature and sensible than you, will misuse them, so nobody is allowed them.

Also, "paternalism" is an irritating dog whistle. We are talking about "public health policy", which also means such sensible things as that you can't have plastic surgery done in a car garage or buy cola sweetened with lead acetate or Cyclamate.

Condoms won't slow the spread of crabs, scabies, or the common cold. Maybe we should ban those too under your logic.

I oppose making a less safe substitute available and I think how people actually act is fair game to consider.

Condoms don't substitute for something equivalent that is safer (some people try to make out that they substitute for abstinence, but that is obviously not true since abstinence is obviously not equivalent).

This device could equivalently substitute for condoms (actually, it's probably cheaper and more fun than condoms as long as you don't mind a small pinprick), but it's less safe. Thus my opposition.

Surely then you are opposed to The Pill and other contraceptives that do not hinder the spread of STDs. A major, if not the primary, reason people use condoms under usual circumstances is to prevent unwanted pregnancies.

This device is not a substitute, nor will anyone with a conscience and a brain present it that way. It is something to be used in addition to existing technologies and sensibilities. It is about increasing available information so that people are able to make more informed decisions.

Denying information is the same kind of "public health policy" that leads to nonsense like abstinence-only sex ed.

That's a different sort of information (how to act to protect yourself) and abstinence-only is not a public health policy. It is a pseudo-religious politician policy.

Now I think about it, you and me both should be fighting the catholic church and the american right over abstinence-only instead of fighting each other over exactly how HIV testing kits should be distributed.

Ah, but what happens when someone just contracted HIV? It's estimated that this is when someone is most highly infectious, and the test won't tell you a damn thing.

I'd like it because it's a bit more convenient than going in every three months, but for testing a date? Bad idea.

Sure as fuck a better idea than not testing a date.

Get real people.

As long as you still use a condom even if the person tests negative.

Nobody is suggesting that you shouldn't.

Full disclosure: I am an HIV-negative gay man with poz friends and acquaintances.

It's counter-intuitive, but it's not a better idea.

Especially when drunk, people have unfocused attention. Signals of trust are amplified. "He's safe, and we don't have a condom, so just this once..." If you go into a hookup thinking every single person is HIV-positive with an entire host of other STDs, you are much less likely to get one.

You don't want to know how many people I've talked to who got HIV from someone they trusted, and "knew" was negative. On the other hand, by law of averages I've slept with at least 20 poz people. I don't know who they are, but I was smart enough to be careful.

The problem is that it could give you false confidence. A person who is recently infected will show up negative in this test. If you have unprotected sex with them, you are 4,000% more likely to get HIV from them than you are a person who tested positive!

I don't think anyone who will go to the trouble of testing their potential partners with this will forego using traditional methods as well. It's a lot more troublesome, after all.

Realistically, in the first world it's gay men who most need to worry about HIV, due both to the greater likelihood of it being transmitted by anal sex and the much greater preexisting incidence among gay men.

http://www.cdc.gov/hiv/topics/msm/index.htm

"A recent CDC study found that in 2008 one in five (19%) MSM in 21 major US cities were infected with HIV, and nearly half (44%) were unaware of their infection." -- eep

Heterosexual college-town hookups? Likely to give you all sorts of things, but probably not AIDS. But expect to see these quick AIDS tests in West Hollywood and the Castro real soon now.

Well, the first thing to note is that the numbers are for MSM - men seeking men. That includes men who identify as straight, bisexual, or other, but who have sex with other men. You may not consider this much of a distinction, but for people who study this, it changes things significantly.

And for straight men who don't want to have sex with other men, it should still be a concern when over a quarter of new infections are suspected to be due to transmission during heterosexual sex.

That's like opposing seatbelt adoption because you think it will increase the rate of fender-benders.

I see what you're saying, but I'd argue it's more like opposing the introduction of comfortable new rubber seatbelts instead of those ugly, old-fashioned webbing ones. Who cares which one works better; people want the convenience only a rubber can give them.

No. An even better example than my first is opposing the installation of air-bags because they might cause people to stop using seatbelts.

Unlike this rubber seatbelt strawman, these tests actually work, and actually have a use. What is their use? Allowing people to make more informed decisions regarding their sex life and HIV. What is HIV in layman's terms? A death sentence. These chips will potentially allow people to avoid an untimely and painful DEATH, and you oppose them because you hypothesise that stupid people might ignore condoms as a result and get something instead that is either not deadly, or require nothing more than a few shots of penicillin.

Opposing the spread of such devices is beyond comprehension to me. It's flat out abhorrent.

You are wildly misinformed! HIV is not a death sentence in first world countries. It's an awful life to live, granted, but it's still a life to live.

The real concern here is that this test isn't accurate for as long as THREE MONTHS after initial infection, and that during that early stage you at at lease FOUR HUNDRED TIMES more likely to pass on the infection. It's not to be used to check if you're still healthy so now you can go bang that hottie at the bar, it's to be used to see if you have HIV and need to get treated.

Isn't the treatment absurdly expensive compared to the median income? How many can afford it, and what do we let happen to those who can't?

> first world countries

Nice qualification. Guess where the majority of people in the world don't live. Guess what the countries with the highest HIV infection rates are not.

Downvotes. Nice. I guess people really don't care about HIV in Africa.

This whole conversation is only serving to make me more and more cynical than I normally like to be. I'm beginning to get the strong impression that there are some members of society that would actually be disappointed if a total cure that could be widely deployed to this plague were found. Like HIV is the enforcer for their idea of proper morals and skin color. I've heard this idea bounced around in LGBT communities before but never really paid it much credence until now.

When discussing it in the context of bars in college towns, I think a "in first world countries" qualification is appropriate.

College kids don't worry about HIV to begin with. They will either wear a condom, or won't. Knowing their partner does not have HIV won't effect the decision since that is the default assumption anyway. People inclined to not make this assumption are also intelligent enough to realize that this test has false negatives.

No, I think where the disagreement lies between you and other posters is that they believe that people are stupid and if they had such a test they wouldn't use condoms... This argument is made for college town and the US (and Europe). And call me cynical but I agree with it, people are dumb, misinformed and would most likely think that they're ok if the test is negative and not bother with condoms. This would actually increase the number of people with aids since people who just contracted aids and are highly contagious will show as negative because they don't have any antibodies yet...

For Third world countries, it's a different matter, I think this test is great. It helps a real problem by providing a convenient way to test for aids to doctors in remote villages and might help slow this awful epidemic...

That argument is absolute shit. The reason people in the demographic of "college towns" use condoms is because they don't want pregnancies, not because they are actually afraid of HIV.

Therefore: 1) This is also an argument for banning The Pill and the like in college towns. Clearly an idiotic idea. 2) Knowing their partner does not have HIV will not prevent people most people from using a condom if they were going to otherwise.

That was my first thought actually. Problem is, do you want to be the company who holds the liability of a false negative?

How do you manage that risk? Otherwise, yes a wallet STD test would be a fantastic little thing to have available in "hook up spots"

No, no no!

Already up to 1/2 of new HIV infections are from people who would test negative in this test; early stage infections. This is because people who have been newly infected are about 4,000% more likely to transmit infection than those who are in late stage infection.

If condom usage dropped even a small amount as a result of this test, it could considerably worsen the epidemic.

From a public health perspective this could be a terrible, terrible disaster.

  ...1/2 of new HIV infections are from people who would test
  negative in this test...

I'm curious what the article means when it says "Researchers at Columbia University claim the mChip has a 100 percent detection rate." Are you sure the test is working the way you think it works? Could it be DNA-based rather than antibody-based?

Yup, I'm sure. The Nature article says it's an ELISA test.

http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.2408....

ELISA is an antibody test.

http://en.wikipedia.org/wiki/ELISA

The 100% detection refers to the detection of the antibodies, not the general detection of HIV infection.

I am -NOT- purposing this as a mutually exclusive alternative. This should be an addition to what's already happening. No one who goes through the trouble of using this is going to say "well she doesn't have HIV, so what the hell, no condom!"

If you're already practicing to be safe, you still worry about the possibility of something going wrong, and you contracting the infection anyway. With this, you can be more certain that nothing will go wrong. You would still use a condom just in case.

Your argument is like saying people engaging in random sexual activity should close their eyes because not seeing warts will lead them to believe the partner doesn't have warts - which may lower then chance they use a condom. This would offer more information, and if it turns out that person is HIV positive by the test, you'd be eliminating your chances of contraction altogether.

No one thinks you are.

The problem is that there is a very real possibility that someone who would go to a bar and test their partner there would then proceed to have unprotected sex instead of using a condom. A test could give them a false sense of security.

While you personally might still use a condom, judging by the reaction to this in the comments on engadget, many would not, not realizing that they actually are putting themselves at greater risk.

When/if this makes this to the FDA, they're going to look at the overall public health risk. If they assess that such a test would lower condom usage, they'd be unlikely to approve it. If you want to market this as such, you'd have to prove that people using it are just as likely to use a condom, and I think you'll have difficulty with that.

The reality is that ELISA tests in the US are cheap and fast enough already; anyone who wants to test themselves faces little barrier. The cheapness of this test is important for countries where that is not the case.

I hear you, but you're arguing that less information is better, and I have a hard time with that. Especially when you're saying that half of new HIV infections could possibly be prevented by this test! I'm not ready to chuck that out with the bathwater.

The problem is one of information interpretation. If the test results were given as either "Positive" or "Unknown", this would solve the issue, yes?

The problem with epidemiology is that it's complex, and I mean that in a technical sense.

For instance, there's evidence that slowing the speed of an epidemic can result in a higher number of total infected.

I'm not at all saying this is bad. Cheap tests are good. However, we already know that test and treat- no matter how cheap it is- will not stop the current epidemic in the U.S. This is an advance in the cheapness of technology but it can't stop an epidemic, only (possibly) slow it. And even that could ultimately result in more people being ultimately infected, but that's not known for sure.

The only technology that can stop the epidemic currently are condoms. The only behaviors that can stop the epidemic are monogamy and using condoms. And it's possible technology such as this could reduce condom usage, and that's the disaster.

From a public health standpoint we need to watch out for anything that can alter behavior on a positive or negative scale. From the comments on engadget I would predict it would impact human behavior in a negative way, and that's what frightens me.

>And it's possible technology such as this could reduce condom usage, and that's the disaster.

// It's also possible that it could prevent promiscuous sexual activity between people that wouldn't have used condoms and are infected.

I wonder if parking sensors increased the number of parking crashes because people stopped looking out of their windows when parking??? Anyone got stats on that?

Well that guy from Wired that test drove the self- driving car with the sensors actually did crash the car the first time he tried to use it to parallel park...

At any rate, the analogy is weak. Testing partners for HIV only makes sense if you're planning to be in a monogamous relationship with them, and ideally should be done 6 months after the start of a monogamous relationship.

You should use a condom with a girl you meet at a bar no matter what. An HIV test doesn't help you at all.

Thanks for the data point.

Interestingly when I first got a cycle helmet was the first time I banged my head whilst cycling, though it was a direct factor (didn't account for the helmet when ducking under a tree). Seatbelts apparently cause some to take more risks.

Prepare for some lawsuits, if your tests says someone's OK but then transmits HIV.

This segues nicely into an idea that occurred to me the other day.

I was knocking around the idea of a website where you sign up with just an email and are issued a unique id, potentially with the ability to generate new ones on the fly. When you hook up with someone, you load an app on your phone or a website, and it generates a QR code. Each partner scans each others code and the website logs the encounter.

At some point, someone is going to get an STD/STI. When this happens, the infected parter can go to the website and with just a few clicks, you can send a notification to your recent (for some medical definition of recent), and they'll be notified to get themselves checked.

Now, the whole HIPAA compliance thing (or compliance in general, since the US isn't the only government affected here) would be a bitch and a half, and getting user adoption would be hard ("you use website.com? slut!"), but if it was safe and caught on, I could see it having a real effect on infection rates.

Some really common infections (chlamydia, gonorrhea) show no symptoms in a lot of cases, so just getting that easy notification could really help people identify that they have the disease, and so they could get quicker treatment.

I just wish I had the skill and finances to try it. Maybe some kid that wants to take a run at YC funding could use this as their idea?

I think it's worth pointing out that while this is great tech, it's still relying on antibody detection, and the incubation period between infection and antibody production can be anywhere from 6 weeks to 6 months. However, you yourself become infectious from a couple of days after infection, and in fact there's often a really high viral load in these early few weeks/months before antibodies start being produced.

Long story short, for the 2-6 months after you first become infected the test would return negative, but you'd still be highly infectious.

40 TIMES more infectious. To emphasize how important this is.

Some researchers estimate up to 1/2 of new infections are from people who would test negative in this test.

A 6% false positive rate? You don't want anyone taking this without probable cause then, else you're going to get a metric crap-ton of people going to their doctor's and having to have a full workup done.

Edit to clarify: My point was that just because it was cheap doesn't mean it'll ever be sold to the public. Apart from anything else, consider the psychological impact of discovering you (may) have HIV from a test kit you picked up from next to the Oreos on a whim.

If you do some searching around you will find 3% to 5% false positive for blood test is not uncommon.

This is true of most tests. When he likelihood of a false positive is significant in relation to the expected incidence, you need corroboration such as symptoms developing before choosing to run the tests.

Sidebar: This is misunderstood by people criticizing doctors who refuse to run tests without corroborating evidence. It's not just the money/scarce resources, it's the problem of false positives dominating actual positives.

Of course at $1/15m/test, a battery of tests is practically built in to the price. If the instructions are to "take three cards and put a drop of blood on each," and that it isn't a positive result unless all three agree, you've solved that problem.

Works for medical professionals, but I think to sell this to the general public, those three cards should be baked in together to avoid confusion.

Highly unlikely that three runs of the same test are fully independant, i.e. they might match all on the same antibody which is similar to an HIV one but not due to a HIV. You likely only prevent operation goof-ups like "oops, spilled a bit of blood from the needle of my bro here ..." (or something less fancy and more likely).

Which is why in practice you run a different test to confirm results.

Wikipedia says that the false positive rate of the standard ELISA test is only 1.5% (thats < 6%) http://en.wikipedia.org/wiki/HIV_test#Accuracy_of_HIV_testin...

and a "positive" result should be confirmed by a Western Blot test. http://en.wikipedia.org/wiki/HIV_test#Interpreting_antibody_...

Statistical note: With a 4-6% false positive rate, this device is only useful where there is a very high probability of infection. In much of the developed world where HIV infection rates are a fraction of one percent, this would mean that the overwhelming majority of positive tests are false positives.

the article claims a 0% false negative rate. This is a MUCH more important claim. False positives are fine, if scary, you go and get a proper test the next day.

The title in the nature.com report includes "in the developing world", so I wonder if this will be one of those products that doesn't really get targetted towards US/EU - where, while we may not have HIV problems anywhere near as bad as in Africa, but a $1 15 minute test would still be insanely useful.

Even if they don't intend to market this to the US I will do whatever I can to see that it is easily available here.

Are you involved in the project?

No.

Innovation in practical use medical technologies is one of my personal passions and frequently on the receiving end of my philanthropy.

Well kudos to you, good sir.

We don't need a cheap ELISA test here- it's already pretty cheap.

What we need is a cheap molecular test, which can detect HIV during early stage infection, when people who are HIV positive are 40 times more likely to transmit the disease.

Maybe a $5/$10 price tag North America could help keep the price around $1 in Africa.

I wonder how this will come to market and how privacy will be protected. I know purchasing a test chip is not the same as confirming HIV positive but it is a data point, just as pregnancy tests are. If it's OTC do you have to consider how easy it is to track?

I could foresee these items being purchased in bulk by individuals. At the $1 price point Bachelors and Bachelorettes around the world might purchase these as frequently as Condoms.

These will never be available over the counter because they would lead to a rash of suicides by people who test positive and are infected as well as the false positives. HIV testing is generally done in conjunction with professional support and not something that should be done at home.

As someone who had a false positive not long ago, I am not gonna be using this anytime soon.

At this price, countries should just purchase a test for everyone, and eradicate HIV.

How would testing everyone eradicate HIV? You'd need to remove the genitals of anyone who tested positive, which I'd imagine would be a little difficult to get through most democratic legislatures.

While his exact point was rather moronic, you could lessen the idea and have a good plan.

Sure, testing everybody in Africa wouldn't get rid of HIV, it would do far more good than just offering them for $1, and it would be a huge step towards eradication - though definitely not the final step.

7 Billion people, $7 Billion dollars to identify everyone with HIV (* plus administration costs). Sure, it won't immediately cure eliminate HIV overnight but it would be a start.

Just like most other disease control campaigns, you appeal to people to change their behaviour, you use social control to support their choice to comply and ultimately you use laws and the iron fist of the state (see smoking or leprosy as good examples).

Seriously, in campaigns to minimise HIV transmission in much of the rich world, they generally use self-interest, people's feelings about their loved ones and the broader sense of social concern as drivers, and above all, non-judgemental honest information - that has worked pretty well in many places (although concern about rapid infection growth in some communities amongst young men-who-have-sex-with-men has been growing recently).

Fear-based campaigning hasn't had a particularly good track record in public health campaigning, at least as far as I recall (just one statistical analysis of road-safety campaigns: http://eprints.qut.edu.au/1839/1/1839.pdf)

And after that, remember to solve the problem of transmission between the intravenous drug users.

I think you'd need to tattoo their foreheads.

[Hmm this'll be an interesting one to watch the votes on].

Reply on news.ycombinator.com