I got worried about HIV, and one of my friends instructed me to monitor my blood ESR ("sed rate"), as it is an indicator to HIV/AIDS infection. Over the past 11 months, my sed rate climbed from 11 to 65. I got worried and got myself tested for HIV. The result was shown as "nonreactive." Please advise me what I should do to monitor any presence of HIV. Should I get another check done in three months?

Thomas

The erythrocyte sedimentation rate (ESR) is a blood test that is frequently ordered in internal-medicine and infectious-disease offices. The test measures the rate that red blood cells (erythrocytes) fall to the bottom of a test tube under controlled conditions. An increased rate, usually defined as greater than 10 in a young adult, generally reflects an inflammatory process somewhere in the body. The ESR can be elevated in a multitude of disorders, from a mild infection, to a severe infection, malignancy or even kidney failure. A normal ESR can virtually exclude some disorders, but it is never diagnostic of any one particular disease.

Your ESR may have been elevated for any number of reasons. The ESR can be elevated in infection with HIV (the virus that causes AIDS), but there are just too many other diseases that elevate the ESR to say that HIV is the cause. To exclude HIV, you need to get an HIV test. It is that simple. If you had a negative HIV test, then in all likelihood, you do not have HIV. As I have mentioned in previous columns, there is a window period of up to six months after infection during which a person may be infected with HIV but routine testing is negative. If you are worried about this scenario, just get another HIV test, not an ESR.

Your question points out one of the dangers of relying on inexpert medical advice. Any physician could have told you that an ESR is a very poor surrogate test for HIV. Any physician would have asked you about risk factors for HIV and ordered an HIV test. Most people, assuming they have a primary physician, would be better off asking him or her questions like these. You could have avoided weeks of worry.