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Chronic corticosteroid use and HIV Tests
Jun 30, 2006

I've seen you reassure many posters who have been treated intermittently with corticosteroids that the steroids will not generate a false-negative HIV test result. I also read, however, that antibody suppression might be possible in patients taking high-dose Decadron for an inoperable brain tumor.

What's the cut-off point? I take high-dose hyrdrocortisone (30mg/day) for primary adrenal insufficiency. I had a negative (normal) HIV test result 6-8 months following my potential exposure (unprotected receptive anal). Aside from one unprotected oral encounter in the interim, I've had no other potential exposures.

Is my HIV test result reliable? (Dr Handsfield at medhelp seems to think so, but looking to verify) If it's not, do patients on consistent, high-dose corticosteroids need to get a PCR test in addition to antibody testing for HIV?

Thank you for such an excellent resource.

-Strata

Response from Dr. Frascino

Hello Strata,

There really is no specific cutoff point. That is, we can't really say 20 mg of prednisone will have absolutely no effect on antibody production, but 25 or 30 mg will invalidate an HIV test. The immune system's ability to make specific antibodies is a highly complex process. Corticosteroids are immunosuppressants that can dampen down multiple aspects of the immune response, including specific antibody production. It is not only the dose of corticosteroids, but also the duration of treatment that can have an effect. In your case, if you've been on 30 mg/day of hydrocortisone for an extended period of time, I would recommend a PCR rather than an antibody-dependent HIV test. I should also point out my strongest recommendation is for you to use latex condoms and practice safer sex to eliminate the need for testing.

Good luck.

Dr. Bob



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