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indeterminate test result
Sep 22, 2005

I have no idea where to even begin. I was in Chile all summer working for an NGO (summer internship). I'm only 22, and I fell in love with the most amazing guy ever. He's only 20, and our connection was so perfect. We did everything right. We didnt sleep together until a month into the relationship, were 100% committed to each other, and always used condoms for sex. We did not use condoms for oral.

My boyfriend, the love of my life, has never lied, and I have no reason to doubt anything he says to me.

He gets a yearly HIV test, and has always tested negative in the past. Last month, however, his test was "indeterminate". I freaked out, of course, and went to get tested right away. I was negative.

We were so in love, however, that it was impossible for us not to continue having a sexual relationship. We remained safe for anal sex, but did not use condoms for oral. I never had cum in my mouth, and we always pulled out even with the condoms.

To complicate my story further, my time in Chile ended. I am back living in Toronto, and my boyfriend remains in Santiago. Our best efforts at a long-distance relationship (I have to finish a year of University) are really being complicated by his still unkown status.

My partner had to go in yesterday to give a third sample of blood. He is still indeterminate, but I have a feeling my worst fears may come true.

I have several questions.

Is it normal to test indeterminate, and what else could cause his test to come back not negative? (I should add that he tested "indeterminate" at another lab, so this could not be the results of a bad lab)

If the worst happens, do I need to be worried about my own health? Is sex with condoms and oral sex without a good way to prevent transmission?

How can I support him while he is going through all of this from 5,000 miles away?

If he is positive, where can I find information on how to continue having a safe sexual relationship with him? I love him with all my heart, and breaking up with him would be terrible for both of us. He, however, has said that if he is positive he intends to just be friends because he would never want to put me at risk.

Basically, I just need some advice. I was just a simple 22 year old college intern who fell in love for the first time and Pandora's box ended up opening. I have no idea what to do or who to turn to.

Thanks

Response from Dr. Frascino

Hi Toronto-Guy,

Now first off, how could you have fallen in love with the most amazing guy ever," while working in Santiago, Chile, when I'm in love with "the most amazing guy ever" and he lives right here in San Francisco??? Well, let's just leave that as an unanswered question and move on to your specific questions, O.K.?

1. Is it "normal to test indeterminate?" Generally no, I would not call it "normal," but it certainly does happen. The causes of an indeterminate HIV antibody test include:

a). Acute seroconversion.

b). 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.

c). Infection with O strain or HIV-2.

d). HIV vaccine recipients.

e). 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.

Your partner has now tested indeterminate on three separate tests run at two laboratories; consequently, we can rule out lab error and/or technical/clerical error. I don't now over what period of time these tests have been run. If he were in the process of seroconverting, we would expect an indeterminate result would become positive over a period of weeks. It is possible your partner could be on of the rare individuals who will continually test HIV-antibody "indeterminate," even though he is HIV negative. It's important to know that "indeterminate" does not automatically (or even eventually) mean "positive."

2. If your partner does seroconvert to HIV positive, your risk of HIV infection would involve "protected" anal sex and unprotected oral without ejaculation in the mouth. Your estimated HIV risk from these activities is very low. If a latex condom was used properly and did not fail, the risk of HIV transmission during protected sex is essentially nonexistent. HIV cannot permeate an intact latex barrier. For unprotected oral sex with a positive partner, the estimated risk for insertive and receptive sex is 0.5 and 1 per 10,000 exposures respectively.

3. Supporting someone 5,000 miles away can be challenging, but is not impossible. Luckily with e-mail and cell phones, the world has become a much smaller place. Although not the ideal situation, it really is possible to "be there for him," even without physically being present. If he knows you are truly "with him," it will help immensely.

4. Where can you find information about safer sexual practices if you r partner is positive??? HELLO??? How about right here? Just check the archives (magnetic couples/serodiscordant couples). Also, it might help you to know that my "most amazing guy ever" (Dr. Steve, the expert in The Body's Tratamientos Forum) is HIV negative. I'm HIV positive. We have been together for 12 years and continue to have romance, passion and mind-blowing, toe-curling sex that most folks only dream about. Don't let your Mr. Right slip away for all the wrong reasons.

Good luck to you both.

Dr. Bob



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