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Consecutive Indeterminate WB Results
Oct 3, 2003

In 1995 I received a letter from the Red Cross and my blood tested Positive for HIV in the ELISA and Indeterminate during the WB test. Now 8 years later I have been retested and the results are exactly the same. Should I be considered HIV Negative or Positive? What have been some reasons for indeterminate results in previous subjects? I have never been in any of the risk categories, so should I be concerned? My current doctor is going to have RNA tests performed to find out whether the virus is present or not. Is the RNA test accurate?

Response from Dr. Frascino

Hello,

I would suggest a qualitative DNA PCR test to detect cell-associated proviral DNA as a definitive test in your situation of indeterminate Western Blots. Because your results have remained constant for 8 years, you are most likely not HIV-infected, particularly because you state there has been no risk. The DNA-PCR has a sensitivity of greater than 99% and a specificity of 98%. Indeterminate Western Blots can occur in 4-20% of people with positive bands for HIV-1 proteins. The causes include:

1. Acute seroconversion. Anti-P24 is usually the first antibody to appear. This would not apply to your case, as results have been the same for 8 years. 2. Cross-reacting nonspecific antibodies, as seen with collagen-vascular disease, autoimmune disease, lymphoma, liver disease, injection drug use, multiple sclerosis, parity (childbirth), or recent immunizations. 3. Infection with O strain or HIV-2. 4. HIV vaccine recipients. 5. Technical or clerical error.

The most important factor in evaluating indeterminate results is risk assessment. Folks in low-risk categories with indeterminate tests are almost never infected with HIV-1 or HIV-2. Repeat testing often continues to show indeterminacy. The viral detection (PCR) test should give you a definitive result which, based on what you have told me and your 2 tests 8 years apart, will most likely be negative.

Dr. Bob



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