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Reactive Elisa but indeterminate Western Blot
Dec 12, 2007

I am a 30 year old married heterosexual male. I am in a monogamous relationship and have had sex only with one woman (my wife). I have indulged in protected vaginal intercourse with my wife and it has been protected. We like taking precautions. We recently decided to start a family and decided to get ourselves HIV tested. As it turns out, my wife is negative but my elisa test came reactive but western blot was indeterminate. I was wondering under what circumstances does the western blot come indeterminate. My doctor advised me to retest after 3 months since I might be in the window period. This is quite a shock to me since I have not indulged in any high risk behavior in the recent past. All my sexual experiences have been with one person and protected. However, I did something stupid when I was very young. When I was 10 years old, I had sexual contact with a 10 year old friend. We would rub our penises against each other. There was obviously no ejaculation since we were so young. We did this around 10-15 times obviously unaware of the risk. I do not know his HIV status but I would be shocked if he was HIV positive at 10 years old. Is is possible to get HIV without ejaculation. His urine might have touched the tip of my penis but I am told that urine has a negligible percentage of HIV to cause infection. Moreover, if I did contract HIV when I was 10, my western blot should be positive and not indeterminate. I am confused and don't know what to do. The fear of HIV is causing me a great deal of anxiety and emotional stress. I am very afraid to even get my self re-tested due to the fear of being positive. Please advise. What are my chances of being HIV positive?

Response from Dr. Frascino

Hello,

Your HIV risk is essentially nonexistent. Why are you freaking out?

Your reactive ELISA and indeterminate Western Blot almost definitely is the result of a false-positive ELISA. (See below.)

Your experience at age 10 is not an HIV-transmission risk. I do not believe you are in the process of seroconverting to HIV-positive. I also see no reason for you to wait three months to sort out your definitive HIV serostatus. I would recommend the following:

1. Repeat your ELISA. If negative, you are HIV negative and no further testing is warranted.

2. If the ELISA is reactive (positive), proceed on with the Western Blot. If the Western Blot is negative, you are HIV negative and no further testing is warranted.

3. If the Western Blot is indeterminate again, proceed on with a DNA PCR (qualitative) test. This test doesn't rely on anti-HIV antibodies and can be helpful in sorting out disputed or indeterminate HIV serologic (antibody) test results.

I'm willing to wager you are HIV negative. Your fears and anxiety are unwarranted.

Dr. Bob

inderminate WB test (INDETERMINATE WESTERN BLOT) Feb 9, 2007

I tested positive in teh ELISA test and have an inderminate result in the WB test. In my opinion, I am a low risk person. In the past 3 years, I have had unprotected sex with 2 different guys, one being in the military, who has tested negative and one who was married for 10+ years before me. I am unsure what bands showed up on my WB test. What is the percentage of an inderminate WB test turning into a positive HIV test? I was told I could not get tested again for 3 months and I have asked my 2 recent sex partners to get tested.

Response from Dr. Frascino

Hello,

Indeterminate Western Blot tests account for 4% to 20% of Western Blot assays in various studies. The causes of indeterminate results include:

1. Serologic tests in the process of seroconversion; anti-p24 is usually the first antibody band to appear.

2. Late-stage HIV infection, usually with loss of core antibody.

3. Cross-reacting nonspecific antibodies, as seen with collagen-vascular disease, autoimmune diseases, lymphoma, liver disease, injection drug use, multiple sclerosis, parity or recent immunization.

4. Infection with O strain or HIV-2.

5. HIV vaccine recipients.

6. Technical or clerical error.

The most important factor in evaluating indeterminate Western Blot test results is risk assessment. Patients in low-risk categories with indeterminate tests are almost never infected with either HIV-1 or HIV-2; repeat testing often continues to show indeterminate results and the cause of this pattern is often not elucidated. For this reason, it's important to realize that HIV infection in situations like yours is extremely unlikely, although a follow-up test in three months is recommended to provide absolute assurance. Patients with indeterminate tests who are in the process of seroconversion usually have positive Western Blots within one month. DNA PCR may also be helpful for sorting out indeterminate serologic test results. An HIV specialist can help assess your HIV risk and interpret HIV test results if necessary.

Good luck.

Dr. Bob



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