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Still worried
Jan 9, 2008

Hello and thank you for all you do here. I am a 32 year old woman who had unprotected sex with a man of unkown status in mid July. On November 6th, my primary care physician ran a test (Western Blot, she confirmed she never did ELISA) and that came back negative. I also took a Home Access test on December 18th which also came back negative. I have two questions:

1. Is Western Blot in the absence of ELISA accurate at detecting HIV at 4 months post possible exposure. Is this a true Negative?

2. How reliable are the Home Access tests? My local AIDS task force says they are only 50% due to user error. Could test false neg or positve. Have you found this to be the case?

Please help, I am still going crazy. Will reach the "official" 6 month mark since possible exposure on January 15th and wondering if you think I should be re-tested. Thank you!

Response from Dr. Frascino

Hello,

1. Western Blot (WB) tests should never be used for first-line HIV screening, due to the level of false-positive results. They should be used only to confirm or negate a repeatedly positive ELISA test. Generally speaking false-negative tests are not a problem with Western Blots, due to their level of specificity. Your negative WB at four months, though ordered incorrectly, is indeed accurate. (If it had been positive, there would have been a chance it could have been falsely positive.)

2. Home Access tests, which use a double EIA (enzyme immunoassay) with a confirmatory IFA (immunofluorescent assay), are extremely accurate. Sensitivity and specificity approach 100%. If they had a 50% error rate, they would be completely useless as a diagnostic test!

Having cleared those points up, I continue to be shocked at the level of incompetence that exists in the medical community regarding HIV testing! Not only did your primary care physician order the wrong test, but your local AIDS task force is spewing out complete nonsense! This reinforces just how far we still need to go to educate physicians and others working in AIDS information services on basic HIV facts regarding HIV testing. The same holds true for HIV prevention, safer sex techniques, sexual orientation issues, etc., etc., etc.

The bottom line for you is that you are HIV negative and no additional HIV testing is warranted.

You should be WOO-HOOing, rather than worrying. You might also consider looking for a more competent doctor and knowledgeable AIDS service organization. The ones you are using aren't doing you any favors.

Dr. Bob



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