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Gallo, Montaigner, gp41+diff test results

Feb 28, 2004

Dr. Bob

I have gone through many posts in this forum, but I'm still confused. Also, from all the ones I read, you and casually Dr. Steve (Im spanish) were my favourites from the begining, and honestly, I did not learn about your relation until two days ago. Funny that while I read both yours and his posts I felt as if you were the same person. Each with a peculiar different touch, but same ammount of kindness and humour behind it. Anyway, happy to know you two are together and teaming up against VIH.

Here it comes:

13 weeks ago during a routine check up my Elisa came up positive. The same Lab ordered a WB. As I could not wait for the results, 2 days later I went to a different Lab (Lab B) and the Elisa came up negativethis calmed me down a little. Next day I got the results of the WB and those were indeterminate with presence of one band (gp41). I can not remenber if it was Gallo or Montaigner who said that gp41 can sometimes be mistaken by celular actin (whatever that is) but on the other hand I also read that gp41 is the most representative protein...! but again that is was hard to find it by itself on a WB as the first one to become positive was p24, SO, as I guess normal in these cases, I had little sleep since and spent much time reading about Elisas and Western Blot results and about 80 of the posts in but nothing I read could really explain an Elisa + a WB ind. and a Elisa (unless lab errors or cross reactions), so after 5 weeks I went to take a thir test and this time with my girlfriend also, to a different lab (Lab C)..woooo-hooooo! Both Elisas came back negative (I also had an antigen p-24 test done that came back negative). I have been together with my girlfriend for 5 years and no other sex relation in between, so that should rule out the possible window period that could explain these results, so I wanted to think that my 2 last Negative Elisas plus my p24 were conclusive (together with my girlsfriend's results) but I could not take away the first positive Elisa followed by the indeterminate WB and the presence of this gp41 band, but I decides I was going crazzy and to continue life. The problem is that about 5 weeks after the first test I started to feel funny behind my ears, no lymph nodes were visible but when I pressed the area I felt a "tingling" sensation. I also started to feel some aches in my armpit and ears that came and went. Again I could not see swollen lymph nodes, but it felt them not right behind me ear and neck (just as I had read). So no wooo-hoooo any more, I started to get nervous again and went for another Elisa 9 weeks after my first Elisa Positive. It comes back negativeso one more..wooooo-hoooo! But it does not last long since for the last 3 weeks I have been having a kind of more than usual continuous red face. I also feel it more hot than it used to be. Is this Rash ? Temperature has been all the time between 36,5 and 37 and one night went up to 37,3 celsius. I have also had, neck aches an a mild sore throat for 2-3 days

I know, you probably think that since I had no risk behaviour why do I worry. An indeternimate WB followed by two negative Elisas with no risk behaviour should not be an issue to worry, but the kind of ars feelings and a personal paranoia keeps me worried. (not to make it even longer, I will explain the paranoia, hopefully, for the x-files, or ex-WW next time I write you, and we will all laught at it) Dr Bob, here are my questions:

(1) Is a kind of red face Rash ? if not, how does it manifests ? (2) Do ARS symptoms come all together or could they come like mine, 1 new symtom every 2 weeks (3) How reliable is an p-24 antigen at 5 weeks ? (4) And a Elisa at 9 weeks(I know best is at 12 weeks)? (5) Due to the symtoms I have hadshould I test further and go for the 13-week Elisa ? (6) I will leave number six for you, so if you have any further comments or advices these will be more than wellcome

Thanks very much for your time. Congratulations for your great job. And.admiration for your strenght and view of life.

Un saludo,

David, (Spain)

Response from Dr. Frascino

Hello David,

Steve and I may be soulmates, but we are not exactly the "same person." In case you need to tell us apart, he's the tall, blond, blue-eyed Norwegian. I'm the shorter, darker, hazel-eyed Italian. As for our "peculiar" touch, well . . .. maybe we should move on to your questions now:

1. No, red face is not consistent with ARS rash.

2. You don't have ARS, so this is a moot point.

3. P24 antigen tests should not be used to diagnose HIV disease. Your ELISA's are negative. That's all you need to confirm your negative status. You can read all about P-24 antigen in the archives, if you wish.

4. Tests prior to 12 weeks are not considered definitive.

5. No, your symptoms are not suggestive of HIV-ARS. You state you've had no risk exposures, you know your girlfriend is HIV-negative, and you've had two negative ELISA's already. Further testing is not warranted.

6. You are correct: Anti-P-24 is usually the first band to turn up on Western Blot testing. P-41 is the most important band; however, a Western Blot is not considered positive unless you have P-41 plus other specific bands. What you had was a false-positive ELISA, confirmed by two subsequent negative ELISA's. Your Western Blot never even made it to a "false positive" status. It was "falsely indeterminate," as proven by your subsequent negative ELISA's and P-24 antigen tests. Your symptoms are not related to HIV, because you do not have HIV. Your tests, taken in total, indicate you are definitively and unquestionably HIV-negative. If you have trouble accepting this fact, you should seek counseling.

I'll even add a #7:

7. I totally agree with you: Your "personal paranoia keeps you worried." That's the problem you need to address.

Stop chasing a disease you could not possibly have. HIV is not your problem!

Feel better. Good luck.

Dr. Bob

best test to rule out hiv

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