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Indeterminate WB w/No Bands
Nov 9, 2007

Negative Ora-Sures, Reactive Elisa and Indeterminate negative WB.

Hi Doctor Frascino, thank you for this work. I'm going to be blunt about some things that aren't pretty, in the interest of clarity.

I am a 20-something professional African American woman. I had vaginal and anal intercourse with and without a condom with two different White hetero males in their early 20's on two different occasions four or five months ago. I have done so a few times with one of these men off and on over the last year. The other was a one time encounter. Neither ejaculated inside me, but I was exposed to their semen near mucuos membranes and their pre-come in my vagina and rectum. I have a hemorrhoid that bleeds occasionally, so there is a compromise in the intestinal lining. I haven't been with anyone else since those times 4 or 5 months ago.

I took an Ora-Sure rapid result test about a month ago (3-4 months after my last risky sex), which was negative. Last week I had a full STD workup as part of a screening process for a volunteer program, and I showed positive for HSV I/II (though I haven't had an outbreak) PLUS for my HIV screening I had a reactive Elisa with an "indeterminate negative" WB. After some research here, I called back and asked my nurse what bands showed up on my indeterminate WB, and she said "none". Everything I'd read seemed to suggest that no bands would be a negative result, so I'm a little confused about that.

In any case, I went back to my nurse 2 days ago and had blood drawn for viral load and other standard confirmatory tests to clarify this indeterminate result. Yesterday was the day on which they do those tests at the lab, and it can take up to 7 days to get the results back.

I went back to a rapid testing center right after I did the blood tests and took another rapid test just so I could have something in my hands, and it came back negative (4-5 months after my lst risky sex).

My involvement with the volunteer program was immediately suspended due to the indeterminate WB, and my involvement was high profile so lots of people are asking all kinds of questions. I stand to lose the biggest opportunity of my career if I'm suspended from this program, which is the least of my worries if I'm HIV positive, but this costly delay is still a terrible blow to my career even if I am HIV negative. Because of how and when this happened, most everyone involved with the program will have to be notified that I may have put them at risk if I'm HIV positive, because some may have been exposed to my saliva. The prospect of telling everyone (I'd be contractually bound to do so) even though their risk is minimal is humiliating.

So that's where I am right now. I will know more definitively in 6 days or less, but every morning I am waking up wracked with terror after a night of nightmares. All day, my hands are trembling and at night I am drinking to numb my anxiety. My career is on hold, on the brink of ruin, with everyone asking me if I know "what's going on" and why everything is stopped.

Most of the reading I've done seems to suggest that a negative OraSure at 3-4 months, then an indeterminate WB at 4-5 months followed immediately by a negative OraSure means that I have at least a viable hope that I'm not HIV positive. But I have had a few risky sexual experiences over the last year and I have HSV I/II plus a compromised intestinal lining. I don't know what to think, and the remaining six days are leaving me a trembling terrified mess.

Without expecting you to predict the future, how worried do you think I should be? Thanks again for your time and insight.

Response from Dr. Frascino

Hello,

Several points in your post don't make sense:

1. If your WB truly had no bands, it would indeed have been negative. A positive screening ELISA plus a negative WB is considered to be a negative HIV test.

2. Your repeat negative rapid test confirms your initial reactive ELISA was indeed a "false positive" (as anticipated).

3. Why would your involvement in a "volunteer program" be suspended due to an indeterminate WB? That makes no sense.

4. How could you have put other members of the program at risk if you are HIV positive? Does the program perhaps involve unprotected sex? Saliva does not transmit HIV.

The bottom line is that you are HIV negative. Your repeat tests will undoubtedly be negative. The rest of your concerns are all related to lack of understanding about how to interpret HIV tests, lack of understanding about HIV-transmission risk and lack of understanding about HIV prevention. You and the members of your volunteer program should spend some time learning the basic facts of HIV/AIDS. Also, I hope you now have also learned that unprotected sex is not worth the potential consequences.

Dr. Bob



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