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False-negative and false-negative tests?
Jun 12, 2000

I work for an AIDS service organization answering HIV-related health questions. This one has stumped me: A woman called to report that she first tested HIV-positive in December 1999 after having a negative test in May 1999. She had two viral load and CD4 tests with the following results: Mid-January 2000: V.L. = 31,000 CD4 = 560 Late January 2000: V.L. = 6,000 CD4 = 553 So far, this seems pretty routine. Here's the unusual part: I talked with her extensively about all the risk factors for HIV transmission (unsafe sex, needle use, blood transfusion, or any other exposure to blood). She insists that her only possible exposure (going back 2 or more years) was through unprotected sex with one male partner. Her partner has repeatedly tested HIV-negative, most recently in April and May 2000. If possible, I'd like your help figuring out the possibilities: 1) Could both her antibody and viral load tests be false-positives? Could any other infection/condition contribute to false-positives in both antibody and viral load tests? 2)Could her partner's antibody tests be false-negatives? Or could he be one of the rare people who don't develop measurable antibodies? If so, would it make sense for him to have a viral test to look for the virus itself? 3) Are there any other tests you'd recommend for either this woman or her partner to help clarify the situation? Thanks very much for your help! E.B. - Boston

Response from Dr. Holodniy

1). Unlikely. Not that I am aware of, particularly on 2 separate days.

2). Maybe and possibly. But did you test him, or is this by verbal report? Female to male transmission is less likely, but it may be warranted to do a VL or DNA PCR test in this case.

3). Not for her, see #2.

MH



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