Aug 9, 2009
So i've encountered a bit of a frustrating situation. I recently went in for an STD/HIV test. All of the tests for the STD's came back negative however an indeterminate HIV test came back. The first doctor basically told me i'm HIV Positive and needed to be seen by the Infectious Disease specialist. During the time for waiting to get in with the ID people, I went and contacted the health department. The health department gave me a rapid test which came back negative, however due to the previous indeterminate test they ordered another ELISA/WB test. I was then able to get into the ID people sooner than expected and they had a viral load test done which they said would clear up any confusion with the indeterminate tests. The second Elisa/WB came back the same as the first. The ID doctor called me back and said the viral load test did not come back normal for a suspected acute HIV infection. It showed approximately 800 copies of HIV (though he didn't provide me with a CD4 count). Is this a common result? Any insight would be greatly appreciated.
Response from Dr. Frascino
Before getting to the results, what about your HIV risk? If you placed yourself at risk for HIV (unprotected sex or sharing intravenous drug paraphernalia), then testing would be warranted three months or more after your last potential exposure.
I'll assume you had an HIV risk and it has been three months or longer since your last potential exposure.
You report your initial screen was "indeterminate." Does that mean you had a repeatedly positive ELISA and indeterminate confirmatory Western Blot? If so and you then had a negative rapid test at the health department, I would at that point assume you were HIV negative.
You report despite the negative rapid test the health department ordered another ELISA/WB, which "came back the same as the first." In order to comment I would need more details about these tests, including which bands on the Western Blot showed up. Remember, an "indeterminate" test is not by definition a positive test. There are a number of reasons for indeterminate WB tests. See the archives for details.
The I.D. doctor also ordered an HIV RNA PCR viral load, which came back at 800 copies (very low). HIV RNA PCR tests are not recommended for routine HIV screening, due to the rate of false positives, other technical considerations and cost. It is possible your 800 copies is a false positive. (I would need to know more about your potential HIV-risk exposures and more details about the HIV-antibody test results before being able to be more certain one way or the other.) Certainly false-positive RNA PCR viral loads are seen more commonly with low level viral titers, like yours.
At this point I do believe there is a distinct possibility you are HIV negative. I would recommend a qualitative HIV PCR DNA test to help sort out the confusing results to date. Also I'm assuming the I.D. physician clarified details on your medical history about the type and timing of HIV-exposure risks and that he reviewed the details of the "indeterminate" results. Combining all this data should be sufficient to give you a definitive answer on your HIV status.
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