Indeterminate WB - Confused
May 25, 2006
Dear Dr. Bob:
In late April 2006 I went for a regular checkup and HIV test. I had a possible blood exposure back in January 2006 in an altercation/fight with a stranger I suspect has HIV. Although I was told the risk would be low I still decided to get tested. I remained confident until my results came back. I was told by my primary care physician that the results came back indeterminate. As you may imagine I became very anxious and nervous. I'm married without children and instantly thought about my wife and the possibility of never becoming a father etc... I didn't know what indeterminate meant and didn't know that there are different types of HIV tests. After coming across The Body I decided to go back to my doc and get a copy of my results. The results for the Elisa had actually come back nonreactive, but somehow a Western Blot test was done and that came back indeterminate (p24 band detected). I spent two weeks of anxiety and great stress. After learning about the DNA PCR test I decided to get tested on my own before my scheduled appointment with a new doctor. This week I received the results from the DNA PCR test and it came back "undetected/negative." The new doctor I saw also ordered that a new Elisa, WB, and DNA PCR be done. I went to the lab for those and apparently they didn't perform the Elisa and WB. They also did the RNA PCR instead of the DNA PCR. Yesterday I went to see the new doc and was told that the RNA PCR came back negative. My question to you is: Are the negative results from the DNA and RNA PCR tests conclusive or should I still be concerned? Should I get tested again for the Elisa and WB? The new doctor I saw wants me to continue getting tested on a monthly basis for three more months just to make sure everything is ok. In two weeks I will go back to the lab for new Elisa, WB and DNA PCR tests. I'm still a bit concerned about the WB test being that there's a chance it may still come back indeterminate. Do you know what causes such a result if it's not related to HIV? I've donated blood in the past (until 2004) and was never notified of an indeterminate result so I don't think I'm one of those people who are lifelong indeterminate. This year (2006) I was given a Tetanus shot (early February) and two Hepatitis B shots (one early February and another early March) plus I came down with an intense flu in April. At the time I went for my checkup and first HIV test I was still recovering from the flu. I've read some of your responses to other questions and you say that immunizations/vaccines may cause indeterminate results. However, if this were the case wouldn't it have led to a positive Elisa result? I'm confused because my Elisa was negative and WB indeterminate. My new doc says that they never should've done a WB once the Elisa was nonreactive. I have also been told by other specialists that in reality I wasn't indeterminate because to be indeterminate I would have had to have a positive Elisa and inderterminate WB test. I hope you can shed my light on my concerns. I thank you for all your effort and enthusiasm in answering questions. I would like to join the fight to educate people about HIV and help those who have it. This experience has opened my eyes not only to HIV, but to life in general and how special it is to live each day to the max and love life. I deeply respect you and thank you for your feedback.
Response from Dr. Frascino
Wow, what a comedy of testing errors (or should that be tragedy of testing errors?). At any rate, I can tell you the end to this comedy/tragedy is indeed a happy one. You are HIV negative.
The first error was running a Western Blot (WB) test inappropriately and without justification. The criterion for WB testing is a repeatedly reactive ELISA. Since your ELISA was non-reactive, a WB should never have been done. You should have been told your HIV test was definitively negative. (WB testing should always be coupled with ELISA screening, due to a 2% rate of false positives.)
Next, your new doctor orders an ELISA, WB and DNA PCR and so the lab runs an RNA PCR only? What the hell is up with that? Who is in charge of your medical facility? Rumsfeld? That's a major screw-up! (Yes, I'm referring to both Rummy and what happened to your tests!) I do not recommend PCR for routine screening, although DNA PCR can sometimes be helpful in sorting out disputed or indeterminate serologic tests.
At this point, you have an initial non-reactive ELISA and follow-up negative DNA PCR. Your WB was run inappropriately and therefore should be ignored. (By the way, anti-p24 is usually the first antibody band to appear on WB testing if someone is truly seroconverting.) Add to this, your HIV risk is negligible to nonexistent. My assessment, considering all relevant information is that HIV is not your problem. No way. No how. No further HIV tests are warranted or necessary.
You can read additional information about the causes of indeterminate WB tests in the archives. I won't reiterate that information here.
Stop testing. Stop worrying. Stay well.
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