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HIV Testing with Immune Deficiency?
Dec 15, 2007

I wanted to ask a question (I think this is the most relevant forum to ask it in) about HIV Testing. I found a couple of similar questions on this forum, but my situation is a bit different so I thought I would ask again... I am an immune-compromised 20 year-old gay man, and have been living with hypogammaglobulinanemia since I was diagnosed 6 years ago. I get intravenous IGG infusions every 5 weeks and my condition is fairly asymptomatic (and, surprisingly to my immunologists due to the fact that it is quite severe, always has for the most part been so). However, I have made a number of stupid mistakes over the past couple of years, having unprotected receptive and insertive anal sex with a number of partners. My immunologist told me that due to my condition, the antibody test would most likely not be effective as I do not naturally produce enough antibodies for it to be accurate.

My question is this: I have seen a number of answers on this site and also heard a number of answers from different doctors. What test should I get in order to determine my HIV status? Who should I ask to do this test (my immunologist, my physician, my health professional at my college, the county health department, etc.)? What is the likelihood that it would give a false positive or negative?

I have attempted to get a test for the actual RNA multiple times over the past year, but because I wasn't sure specifically what to ask for, half of times I've been given an antibody test anyway, and the other times I wasn't really sure exactly what test I was given. Thus, any insight you could give would be amazing. Thank you so much in advance!

-Unsure

Response from Dr. Frascino

Hi,

I agree with your immunologist: Tests that rely on production of specific antibodies would not be accurate in someone with hypogammaglobulinemia severe enough to warrant IVIG infusions on a regular basis. I would recommend an "HIV DNA PCR Qualitative Assay." This type of test detects cell-associated proviral DNA. It is not FDA-approved for this use, but in your situation it's probably the best option. HIV RNA PCR tests are quantitative viral load tests. The false-positive rates are between 2% and 9% and occur usually at lower viral titers (less than 10,000 copies per milliliter). As for whom to ask to order this test, I would suggest your immunologist, as he is the most likely to have a good understanding of the tests and their various limitations. You can show him a copy of this post if you feel it would be helpful.

Finally, remember "stupid mistakes" can be easily avoided by a thin piece of latex!

Good luck.

Dr. Bob



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