Dear The Body,

Im a 45 year old homosexual male. In the last two years Ive been going through some uncertain times regarding my HIV diagnosis and would appreciate your help in understanding my situation.

On February 2007 I took a routine rapid HIV test in a local testing center, I like to do so every 6 months or so. The test result was negative which I welcomed although it came as no surprise. Im sexually active but always take care of myself and practice safe sex for intercourse. Im not quite as strict for oral sex; however, do not exchange fluids during such. A week later I had scheduled my yearly physical and when my doctor asked if I wanted to have and HIV test, I hesitated but answered affirmative as I understand this would be a more accurate test and would be nice to have it on my medical history for tracking purposes.

The bloodwork results came back with a lowered cholesterol level and everything else normal but to my surprise the HIV test came back reactive. I was quite shocked since a week earlier the test came non-reactive. He wanted me back to retest and also have the western blot and viral loads tests done. So that in early March I got the new results back: the HIV antibody still reactive, the western blot was indeterminate with the P24 band showing equivocal, and the viral load undetectable (less than 400 counts). He put me on Atripla and asked me back in 3 months. The June test results were the same except that this time he requested the more accurate viral load test, which also came back undetectable (less than 40 counts).

He asked me to remember any bad flu or cold that lasted a week and that would have made me quite weak, which I could not remember at all. Actually that spring I had been feeling quite healthy and did not even have my regular once-a-winter cold. I had traveled to Spain and England during the Christmas holidays and had fooled around with guys in both places, but nothing stood out in my mind as an unusually risky situation.

Now comes the strange episode. I had gone through a significant adaptation to my new status, and became consequential to my new circumstances; playing safer and taking better care of myself. Then when I went back to the next round of tests in October, the HIV antibody comes back non-reactive, the viral load still undetectable, but this time since the antibody test came back negative the lab skipped the western blot (I understand the western blot is routine only when the results are positive). We were both puzzled, doctor and I. He suggested continuing the Atripla and returning this time in 6 months for the next round of tests.

In the beginning I had some trouble adjusting to the Atripla but by now I had hardly any side effects so I did not mind continuing the treatment, especially since the results seemed to have taken a turn for the better. I did extensive research un the subject but did not find more than a few seemingly hoax stories on sero-reversal (one in London that seemed quite a financial scam) or the more believable ones were on children born from positive mothers that initially test positive but revert right away. Nothing I could relate to.

In April 2008 I went for the next round of tests, which came back in early May: HIV antibody indeterminate, HIV2 test negative (trying to rule things out), no western blot, and undetectable viral load. Continued the Atripla and waited for the next round of tests, which took place in August 2008. The results this time indicated the HIV antibody non-reactive, (therefore) no western blot, and undetectable viral load. My doctor again suggested continuing the Atripla.

My latest and most recent round of tests, in December 2008, turned out similar results except that this time he was explicit in requesting the western blot regardless of the HIV antibody, which again came back non-reactive. However, the western blot indeterminate again, with band P24 equivocal again.

This whole situation did not bother me as much until now in that I have handled the Atripla quite well and the results seem to be more consistent on the antibody results being negative, a trend I welcome. However, with a strong possibility of being laid off from my job and the need to then secure medical insurance on my own, the question of what is my HIV status seems more relevant now than ever. Being HIV positive puts me in a different insurance bracket. Additionally I would just like to know what all the results really mean and whether continuing the Atripla treatment makes sense or not as much once the results turned negative. Again, Im tolerating it quite well but it is a strong chemical that I would rather not take unless it is clearly necessary, in which case I would not mind continuing.

Any insight or similar cases that you may be aware of would be greatly appreciated. Thank you very much.

LP

The decision to start Atripla is interesting and could be confounding the results in your case. You don't indicate what the CD4 count and percent was prior to starting HIV treatment. If the CD4 count was relatively normal, you could consider stopping the Atripla and see what happens to the HIV antibody tests and viral load. Alternatively, you could obtain an HIV DNA test, which looks for evidence of HIV inside the cells and should be positive even though the viral load test is undetectable.