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mixed results and likelihood-your experience
Oct 5, 2003

Hey Dr. Bob, Please answer this one! I have to wait 1 more month before a possible WOO-HOOO and I'm going nuts. I'd love your feedback because of all the sites I've seen, you seem to give the most straight-forward and balanced view. With all the stats and data on HIV, I find it amazing how hard it is to find info on how often mixed test results ultimately show true infections upon repeat at 90 days. I know you can't offer a diagnosis or provide specifics, but in your own experience and from your studies, could you in general say how often you see the following result scenarios later become positive (even "usually", "half and half", "seldom", or "never seen" would suffice):

1) a + ELISA and a negative Blot at the 35-40 day mark from possible exposure 2) a negative qualitative PCR at around the 40-50 day mark 3) combo -- #1 above followed by #2 result at 50 days

If you can't answer, do you at least have a link or any references where I could find such info? Would be greatly appreciated. Some stuff I read make it sound like anytime you get a + ELISA, no matter what else, you are likely infected and in seroconversion. But, another report I saw said even most "indeterminant blots" ultimately become negative. If you could either give your experience on the 3 above, provide a link, or comment on these last 2 observations...and provide the address for donations, I'll send one (not completely a bribe, I think you do amazing work for a great cause). By the way I'm # 3 above and my risk was unprotected cunninglus but protected vaginal with an escort. Thanks!

Response from Dr. Frascino

Hi,

How often would the following scenarios later become positive??? OK, let's take them one at a time.

1. Positive ELISA and negative Western Blot 35-40 days from possible exposure. There is no answer to this question, because ELISA tests are not definitive until at least 3 months after a potential exposure. So let's assume someone had these results at 3 months, instead of 35 days, OK? A positive ELISA and negative Western Blot is considered a negative HIV test. (The ELISA would be a "false positive.")

2. A negative qualitative PCR at 40-45 days post-exposure. This depends a bit on whether it was a DNA or RNA PCR; however, in general, seroconversion following a negative PCR at 40-50 days would be rare. I must quickly add, however, that the specificity of PCR tests is not considered sufficiently accurate for HIV diagnosis without confirmation. That means you shouldn't use this test alone to try to routinely diagnose an HIV infection.

3. #1 followed by #2 at 50 days. My response to combining those 2 test results would be to combine my 2 answers. ELISAs performed prior to 3 months are not reliable; therefore, I can't give you even a hypothetical answer. A negative PCR at 50 days would be very encouraging, but that test is not recommended for routine screening.

So what do I think about your chances for a WOO-HOO? Well, first let's look at your risk. What is "cunninglus?" I'll just assume it's cunnilingus and not some weird Kama Sutra position that John Ashcroft would have you arrested for, OK? So your risk is unprotected oral and protected vaginal. That means your overall risk is negligible. So based on that alone, a WOO-HOO is extremely likely. Add to that a negative PCR at 40-50 days and I'd say your chances of being positive are similar to that proverbial snowball's chance in hell.

The Foundation's address is:

The Robert James Frascino AIDS Foundation 779 Altos Oaks Drive, Suite 200 Los Altos, CA 94024

Stay well. And folks, please note: I very much appreciate the donations to my Foundation, but I do not accept bribes. I'm here to help everyone.

Dr. Bob



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