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Indeterminate WB - Possibility of HIV2?

Aug 27, 2006

Hi Dr. Bob:

First let me say a BIG THANKS for all your help and support. I've checked out your responses to questions similar to mine and it has been very helpful.

Now I would like to personally ask you about my specific situation. I'm a 30 yr old male living in NYC. Back in early February 2006 I had protected sex with a woman whose HIV status I don't know, but I did have unprotected oral sex with her(with me giving). She did have some vaginal fluid which is now a concern for me because I decided to go for an HIV test on April 29th with mixed results. My Elisa came back "nonreactive" but my WB came back indeterminate (p24 band present). Both tests were for HIV 1.

I was tested again on June 2, 2006 for HIV 1 Elisa, WB, PCR DNA and PCR RNA. My results for the Elisa was "nonreactive", WB was still indeterminate with the same band present (p24), PCR DNA was "not-detected," and PCR RNA was "not-dectected." My doctor also ordered HIV 2 Elisa and WB tests to be on the safe side. He told me my HIV 2 Elisa came back positive, but WB came back negative. He then told me that the HIV 2 Elisa test is not perfect. He said it's not as sensitive as the HIV 1 Elisa and sometimes comes back positive even when people haven't engaged in any high risk behavior. Nonetheless I'm a bit confused with my results because in my mind I'm thinking "what are the odds of having a Negative HIV 1 Elisa with an Indeterminate WB (p24) combined with a positive HIV 2 Elisa and Negative WB? Although the June 2nd tests were at approximately 4 months of possible exposure my doctor said he believes I don't have HIV, but he referred me to a specialist for a second opinion just to be safe. A few days ago I went to see the specialist and he ordered HIV 1 & 2 Elisa and WB tests. However, he didn't order HIV 1 PCR tests because he felt that those would come back negative. Now I'm awaiting the results of those tests. These new tests would be at approximately 6 1/2 months of possible exposure.

It seems to me that my case is rather complicated. This is why I decided to get your feedback. Please let me know what you think and if it's true that the HIV 2 Elisa test isn't a really good or highly reliable test. At this point given the negative Elisa and PCR test results for HIV 1 I feel quite confident that I don't have HIV 1 despite an indeterminate WB result, but my concern has to do with HIV 2. In case my new test results come back the same is there a PCR test for HIV 2? If so, is it reliable? I'm aware that HIV 2 is rare in the U.S., but I suppose that not knowing too much about the person I was with I can't say with certainty whether or not she has had any partner(s) from countries where HIV 2 is much more present.

Lastly, I would like to note that I was given a Tetanus shot back in January and my doctor also gave me the Hepatitis B vaccine on Feb., Mar. and July of this year. I'm not sure if those are major factors, but I figured they are worth mentioning.

Please let me know what you think about my situation. Also, please send me some good charma. I sure need it. I appreciate your feedback. Hope to hear from you soon. Thanks for all your help and support.

Response from Dr. Frascino


Your results are confusing, only because the tests were ordered and interpreted incorrectly. From all the information you present, it is quite clear that you are HIV-1 and HIV-2 negative.

Let's start with your risk. Protected sex is "protected," if the latex condom was used properly and did not fail. Cunnilingus carries at best a negligible risk for HIV transmission.

Next, your tests and their interpretation:

1. Your April 29 ELISA was "non-reactive," which means you're HIV-1 negative. A Western Blot should never have been run on a negative ELISA. Western Blots are only useful in confirming repeatedly reactive ELISAs. When run on non-reactive ELISA samples, they will have between 4% to 20% indeterminate results for a variety of technical reasons. Therefore your initial test should have been reported out as "negative for HIV-1." Period.

2. Your June 2 results reveal exactly the same situation as above with the ELISA and WB. In addition, you had a PCR DNA and a PCR RNA, both of which were "non-detected," corroborating what we already know: you are HIV-negative.

3. The HIV-2 tests revealed a positive ELISA, but negative WB, which means your ELISA is a false-positive and you are HIV-2 negative (because the Western Blot is the more sensitive assay).

Consequently, all your testing is consistent. You are HIV-1 and HIV-2 negative. Chances are your repeat HIV-1 and HIV-2 tests will confirm this. I agree there is no reason to order additional PCR tests. In fact, even the repeat HIV-1 and HIV-2 screening tests aren't really necessary in my opinion. With such a minimal risk and the extensive testing you've had so far, I would say HIV is not your problem. No way. No how.

Finally, neither a tetanus vaccine in January nor your hepatitis B vaccine series would affect your HIV tests in April/June.

Good karma? Sure, it's been packed, sealed and sent with my compliments, even though in reality I doubt you need it!

Dr. Bob

in limbo...please read!
integrase inhibitors,where are they?

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