Hi Doctor Bob in order to remember my case I am the man who has congenital adrenal Hyperplasia and has a PCR reduction after steroid reduction dose this is the link to remember my case http://www.thebody.com/Forums/AIDS/SafeSex/Archive/Other/Q190924.html

1- I dicover that high result of PCR was due to old kit and not real time PCR as used in undetectable result kit

The lab who give me positive PCR was using old rechniq and not real time 40-10000000 range The same thing with CD4 issue it was technitian error 2- No specialist able to sort out my case even with undetectable PCR DNA I have done in Germany by sending my sample abroad 3- I still has positive WB 4- i got last PCR RNA result done in Jordan result of 36 Copies , they consider me positive because they said the kit we have can read start from 25 copies . Is this true that there are PCR kits can read below 40 . Is this new invention in arabic country

5- According to my results in PCR DNA am I ellite controller or something else

You know doctor bob my life become misrable because I am standing in middle no one in my area want to confirm my HIV infection becuase of undetectable PCR with 3 healty kids with their mom in addition of that my CD4 keep moving up with steroid reduction

Please advise

Hi,

You appear to have solved your own conundrum! If your detectable PCR results were due to a technical error (outdated kits) and your low CD4 count due to a "technitian error," we can eliminate those results from your case. More recently it appears you've had an undetectable PCR DNA (from Germany). That would correspond to your history of no HIV-exposure risk. You also report a positive WB. Did you have a repeatedly reactive (positive) ELISA prior to getting the positive WB? If not, the WB is most likely a false positive. The other possibility, an elite controller, would be much more unlikely, as you have essentially no HIV risk. You would need consistently positive ELISAs and confirmatory Western Blot tests plus a persistently undetectable HIV plasma viral load to be an elite controller. Your case is difficult to sort out over the Internet, as I don't have access to your complete medical file and all of your laboratory tests or have the benefit of a physical examination. However, from what I've been able to glean, I would surmise you are HIV negative, not an elite controller.

Good luck.

Dr. Bob

PCR negative after steroide reduction again Feb 24, 2008

Hello,

My opinion hasn't changed. Corticosteroids can suppress immune responses and might cause a falsely negative HIV test by suppressing the immune system's specific anti-HIV antibody production. Corticosteroids should not cause a false-positive HIV antibody test, although a number of other things can. You can read about these in the archives. Also "false positive" HIV antibody test results would not explain elevated HIV plasma PCR tests, which have absolutely nothing to do with anti-HIV antibodies! As I mentioned in my initial response, you have essentially no HIV risk from what you've told me. Consequently your positive test result was inconsistent with potential risk, thereby suggesting it was indeed falsely positive. Your results are still a bit of a conundrum, due to the two significantly elevated PCR tests. Without the benefit of actually reviewing your entire medical file and related test results, I can't offer a concrete explanation. However, an HIV specialist or clinical immunologist most likely would be able to sort this out for you by reviewing your chart and results in detail. I do agree with your recent infectious diseases doctor that your chances of being HIV positive are essentially nil.

Dr. Bob

I think you will remember my case from your archeive.

Dr. Bob it is sorry to say that my doctor in infectious diseases change his mind and confirmed my positive HIV due to new result of PCR from another lab which came back 32000 . I done two PCR in two well known labs the two PCR done in the same day with the same blood but divided and delivered to two labs . the first lab PCR result was undetectable and the second was 32000 . then the two managers for both labs repeat the test after one week with new boold sample and they did the same exercise by dividing the blood sample and work seperatly with same blood sample the result came back undetectable for first lab and 4000 for the same lab who made my PCR 32000 before one week . The two labs are so confused because they do not have an explanation for me if I am positive PCR or not .

Note : 1- both PCR kits are real time and done a control 2- both have taken one sample from a positive PCR patient who has 50000 result in lab one and his result was 40000 in the second lab . this patient tests done on the same time of my test at the same two labs this is to confirm that there is no technical errors in my results .

The same above PCR exercise done for my CD4 . the first LAB cd4 result is 62 ( AIDS stage ) with the same blood sample my CD4 result in the second lab was 498

both lab they are accurate and no explanation of my result dancing .

The important thing that my doctor in infectious desees was very sure I am false positive HIV due to two elevated PCR result which you described in your previuos ansewr in a word of ( conundrum ) but he change his mind suddenly due to lab result flip flap inspite of the physical exam he done in my body and his confirmation that I do not have any single HIV symptoms by physical check and inspite of having three kids without infecting my wife since 6 years of marriage .

The question : Is HIV not STD concerning my case

You will tell me that since I am positive in Western blot test it means i got HIV and i have to move in my life and use condoms with my wife after all of this years of marriage only because WB is positive

I am not normal patient I am steroid user since 36 years and there is still no cut off point in steroid affect in HIV tests

Please help me

Response from Dr. Frascino

Hello,

Clearly something isn't adding up here. And with only limited information I may not be able to sort it out for you over the Internet. However, split blood samples that give two completely different results would indicate a laboratory technical or clerical problem. My opinion has not changed based on the new information you provide. Your situation also clearly illustrates why I do not recommend PCR RNA quantitative tests for routine HIV screening. False-positives, particularly at low viral load titers, are not uncommon.

I will offer two pieces of advice:

1. Consult an HIV specialist. If you are writing from the USA, you can check the American Academy of HIV Medicine's Web site (www.aahivm.org) for a list of certified HIV specialists listed by locale.

2. Consider getting an HIV PCR DNA qualitative test. Although not FDA approved for this use, it can be helpful in sorting out disputed serological results and indeterminate tests. (Note this test is different from the PCR RNA Quantitative tests you have been getting.)

I would urge you not to run CD4 counts or PCR RNA tests unless you are confirmed to be HIV positive. I still strongly doubt this is the case. The HIV specialist may well be able to help you sort out which laboratory is providing the faulty results. (You can't have a CD4 of 62 and 498 on the same blood specimen!)

I will repost your original question below.

Good luck.

Dr. Bob

PCR negative after reduction steroid dose Oct 26, 2007

Hello,

Although long-term use of immunosuppressive agents, such as corticosteroids, can affect HIV-antibody-test results, this would cause a false-negative result, rather than a false-positive result. The reason for this is that corticosteroids can suppress the body's ability to make antibodies, including anti-HIV antibodies. Consequently, someone who is HIV positive and on significant corticosteroids could test HIV negative (false-negative). Corticosteroids also would not affect HIV PCR RNA viral load test results.

Having said that, is there any way your test result could still be inaccurate? Yes, absolutely. You report that your wife is confirmed to be HIV negative and that you have had essentially no risk exposures monogamous since getting married and minimal sex before marriage, all of which "safe sex." Assuming that you are not an IV drug user who shares syringes and have not received a blood transfusion of HIV-tainted blood, you have essentially no risk. Consequently, your recent positive test is inconsistent with your potential risk. The most likely cause for this is not your congenital adrenal hyperplasia or use of replacement steroids, but rather a technical or clerical error. Someone could have mixed up the samples or your results. I would suggest a repeat ELISA test and, if positive, a confirmatory Western Blot as your next step. If those are again positive, a repeat HIV plasma viral load and visit to an HIV/AIDS specialist should be scheduled. The specialist will review all the lab results, your personal medical history and your current medications. If needed, he will order additional tests to clarify your status.

I'm sending you my very best good-luck/good-health karma that your follow-up tests prove that your initial tests were in error! Keep me posted! I'm here if you need me, OK?

Good luck!

This is your answer to me long time back

I consult endorcinlogist he suggest that long period of using prednisone might interfer in my HIV tests then I reduced the dose into 6mg daily my CD4 increase from 540 into 690 then PCR from 56400 into 30000 but WB still positive then after 6 months i reduce the dose into 4mg and wait for one months then tested WB still positive and PCR become undetectable ( surprise ) My wife pregnant in 5th months in our third baby she still negative

[Please advise me as i consider myself havea false positive HIV caused by steroid , I read most of www.thebody.com archeives I conclude there is no cut off point in steroid affect in HIV tests ( antibodies ) and I have to consider the negative result of my PCR to move on in my life before one week I visited another consultant in infectios dieseas i told him my story since one and half year and he made a phisical check in my body and he told me that 99% you are suffering from long term use of steroid and this creat false positive HIV antibodies and you have to do another tests after 6 months to monitor your result especially after changing my mediecine from 4mg of prednosone into 20mg of hydrocortisone because hydrocorisone better in short acting dose .

Please advise Is passing sucssefully the phisical exam and Negative PCR is the final approve of not holding HIV

Thanks

Response from Dr. Frascino

Hello,

My opinion hasn't changed. Corticosteroids can suppress immune responses and might cause a falsely negative HIV test by suppressing the immune system's specific anti-HIV antibody production. Corticosteroids should not cause a false-positive HIV antibody test, although a number of other things can. You can read about these in the archives. Also "false positive" HIV antibody test results would not explain elevated HIV plasma PCR tests, which have absolutely nothing to do with anti-HIV antibodies! As I mentioned in my initial response, you have essentially no HIV risk from what you've told me. Consequently your positive test result was inconsistent with potential risk, thereby suggesting it was indeed falsely positive. Your results are still a bit of a conundrum, due to the two significantly elevated PCR tests. Without the benefit of actually reviewing your entire medical file and related test results, I can't offer a concrete explanation. However, an HIV specialist or clinical immunologist most likely would be able to sort this out for you by reviewing your chart and results in detail. I do agree with your recent infectious diseases doctor that your chances of being HIV positive are essentially nil.

Dr. Bob