Hello,Dr.Joe, thank you very, very much for your answer, I was in a terrible state of anxiety! My last question and I hope you endure with me: Are those people who are negative sera-positive PCR are either seroreverters or newly infected,or is there more to it? http://www.aidsmap.com/en/news/C30FBBD2-588A-441D-9E88-83F59309887F.asp http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102182144.html

Thank you for the follow-up.

Most patients who test negative on the screening antibody test but who are positive on the PCR viral load test are "pre-seroconverters" which means they are very recently infected (within a couple of weeks) and have not had time to build up antibodies yet. They will often have very high viral loads and mostly have symptoms of an acute viral infection: fever, sore throat, swollen glands, sometimes a rash or sores in the mouth...something like the flu or mononucleosis. There has been much effort to be sure that docs in Emergency Rooms and clinics recognize and learn from these cases so they think about using HIV testing and PCR in the appropriate way. The other scenario, much more rare (only 16 cases ever reported in the world) is when people may have lost their immune response to HIV due to very advanced illness. These people have come in with opportunistic infections...if someone has confirmed OIs then looking for HIV by PCR might be reasonable. It would not be worthwhile for more general/non-specific symptoms because the finding is so rare.

Thanks, Joe