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PCR RNA testand genotype
Apr 18, 2006

Hello Doc , Its me the guy who had asked the PCR test which came back at 899 copies. Thanks for your answers , I know you would be getting tons of emails from stupid dumbass idiots like me after a low risk of receiving a unprotected BJ from a sex worker.

I received a final report and the quest diagnostics does a automatic HIV-1 Genotype test, in whcih the results were - "RT- Gene Mutation -Test not performed - We are unable to amplify viral RNA to sequence the protease and the reverse transcriptase genes, The likely reasons for failure are insufficent virus or ad inhibitory substance in the sample. Corelate result with a recent viral load test."

PR Gene Mutaion - Same as above.

I have contacted a HIV speaclist and he also agreed that this 899 copies of viral load would be false positive and he really wanted to yell at me for taking this test but did not and explained to me properly. At that time I had this partial report of 899 copies and did not have the GENOTYPE result, I am send this report copy to him. I wanted to get you opinion is this more promising that the $ i spent on this test is truely false positive. I Promise I would be donating double this test amount at the end of my 3 month result.

Thanks once again.

Response from Dr. Frascino

Hi,

Welcome back to the forum.

Quest diagnostics, or any other lab for that matter, does not run "an automatic HIV-1 genotype test." That test has to be specifically ordered and is quite expensive, as I'm sure you have already found out. It is a resistance test that tries to identify genetic mutations within the reverse transcriptase and protease enzymes that would suggest resistance to certain antiretroviral medications. The test has absolutely nothing to do with HIV-diagnostic-screening tests. Due to technical aspects of how these genotype tests are performed, they cannot generally be done when the HIV viral load is less than 1,000 copies. The statement on your lab report reflects this fact. Unfortunately, and for reasons I do not understand, someone ordered these tests for you completely without justification. If these were suggested and ordered by your doctor, I'd strongly suggest you search for a new, more competent physician.

The bottom line is that HIV-1 reverse transcriptase and protease genotype assays mean absolutely nothing in your case and should never have been ordered.

I'm not surprised the HIV specialist agreed with my assessment that your PCR was a false positive. If he wanted to yell at you for taking that test, just wait until he sees this one. (I suggest you put cotton in your ears, as the yelling could be intense.)

My opinion and advice remain exactly the same as my first response (see below).

Good luck.

Dr. Bob

resubmitted, HIV-1 RNA at 899 copies Apr 15, 2006

Hello Doc ,

I recenlty had a exposure of receving oral sex from sex worker . 4 week oraquck was negative , and had hiv1-rna pcr which they say priliminary test has 899 copies. I want to know is this really true and wat are the false positive with this test , Can a normal cold i had could affect this test ?, I am about to break down . thanks and keep up the good work. I have donated previoulsy and will do so in future.

Response from Dr. Frascino

Hello,

First a couple of facts:

1. Oral sex carries an extremely low risk for HIV transmission.

2. HIV-antibody tests taken prior to three months from the time of potential exposure are not considered definitive or conclusive, and are therefore not recommended.

3. HIV PCR RNA tests are not recommended for routine HIV screening due to the rate of false-positives (2% to 9%) and cost.

4. A "normal cold" would not affect HIV-antibody test results. With these facts in mind, you should, at this point, be able to realize several things:

1. Your HIV risk is minimal.

2. Your four-week OraQuick test is not definitive.

3. Your HIV PCR RNA should not have been done.

By following the rather straightforward guidelines for HIV testing, all of your worry could have been avoided. Your current dilemma is exactly what I try to caution people about when they begin freaking out after a minimal to no-risk exposure and then immediately run out and get inappropriate HIV tests. (I hope those reading this forum will take note of this gentleman's very avoidable problem and not make the same mistakes!)

OK sir, I'll step off my soapbox now and get back to your question. As I mentioned, your HIV risk is extremely low at best. Your four-week negative OraQuick is encouraging, but not definitive. Your HIV-1 RNA PCR is most likely a false-positive. False-positive tests occur in 2% to 9% of folks without HIV infection, virtually always with low HIV RNA titers (less than 10,000 c/ml) like yours. People experiencing acute retroviral syndrome prior to seroconversion generally have HIV RNA levels that are extremely elevated, usually in the 100,000 to 1,000,000 c/ml range. My advice to you is to stop worrying and follow the HIV testing guidelines. That means get an HIV-antibody test at the three-month mark. By all indications it will be negative.

Good luck!

Dr. Bob



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