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PCR negative after steroide reduction again
Feb 24, 2008

Hello,

My opinion hasn't changed. Corticosteroids can suppress immune responses and might cause a falsely negative HIV test by suppressing the immune system's specific anti-HIV antibody production. Corticosteroids should not cause a false-positive HIV antibody test, although a number of other things can. You can read about these in the archives. Also "false positive" HIV antibody test results would not explain elevated HIV plasma PCR tests, which have absolutely nothing to do with anti-HIV antibodies! As I mentioned in my initial response, you have essentially no HIV risk from what you've told me. Consequently your positive test result was inconsistent with potential risk, thereby suggesting it was indeed falsely positive. Your results are still a bit of a conundrum, due to the two significantly elevated PCR tests. Without the benefit of actually reviewing your entire medical file and related test results, I can't offer a concrete explanation. However, an HIV specialist or clinical immunologist most likely would be able to sort this out for you by reviewing your chart and results in detail. I do agree with your recent infectious diseases doctor that your chances of being HIV positive are essentially nil.

Dr. Bob

I think you will remember my case from your archeive.

Dr. Bob it is sorry to say that my doctor in infectious diseases change his mind and confirmed my positive HIV due to new result of PCR from another lab which came back 32000 . I done two PCR in two well known labs the two PCR done in the same day with the same blood but divided and delivered to two labs . the first lab PCR result was undetectable and the second was 32000 . then the two managers for both labs repeat the test after one week with new boold sample and they did the same exercise by dividing the blood sample and work seperatly with same blood sample the result came back undetectable for first lab and 4000 for the same lab who made my PCR 32000 before one week . The two labs are so confused because they do not have an explanation for me if I am positive PCR or not .

Note : 1- both PCR kits are real time and done a control 2- both have taken one sample from a positive PCR patient who has 50000 result in lab one and his result was 40000 in the second lab . this patient tests done on the same time of my test at the same two labs this is to confirm that there is no technical errors in my results .

The same above PCR exercise done for my CD4 . the first LAB cd4 result is 62 ( AIDS stage ) with the same blood sample my CD4 result in the second lab was 498

both lab they are accurate and no explanation of my result dancing .

The important thing that my doctor in infectious desees was very sure I am false positive HIV due to two elevated PCR result which you described in your previuos ansewr in a word of ( conundrum ) but he change his mind suddenly due to lab result flip flap inspite of the physical exam he done in my body and his confirmation that I do not have any single HIV symptoms by physical check and inspite of having three kids without infecting my wife since 6 years of marriage .

The question : Is HIV not STD concerning my case

You will tell me that since I am positive in Western blot test it means i got HIV and i have to move in my life and use condoms with my wife after all of this years of marriage only because WB is positive

I am not normal patient I am steroid user since 36 years and there is still no cut off point in steroid affect in HIV tests

Please help me

Response from Dr. Frascino

Hello,

Clearly something isn't adding up here. And with only limited information I may not be able to sort it out for you over the Internet. However, split blood samples that give two completely different results would indicate a laboratory technical or clerical problem. My opinion has not changed based on the new information you provide. Your situation also clearly illustrates why I do not recommend PCR RNA quantitative tests for routine HIV screening. False-positives, particularly at low viral load titers, are not uncommon.

I will offer two pieces of advice:

1. Consult an HIV specialist. If you are writing from the USA, you can check the American Academy of HIV Medicine's Web site (www.aahivm.org) for a list of certified HIV specialists listed by locale.

2. Consider getting an HIV PCR DNA qualitative test. Although not FDA approved for this use, it can be helpful in sorting out disputed serological results and indeterminate tests. (Note this test is different from the PCR RNA Quantitative tests you have been getting.)

I would urge you not to run CD4 counts or PCR RNA tests unless you are confirmed to be HIV positive. I still strongly doubt this is the case. The HIV specialist may well be able to help you sort out which laboratory is providing the faulty results. (You can't have a CD4 of 62 and 498 on the same blood specimen!)

I will repost your original question below.

Good luck.

Dr. Bob

PCR negative after reduction steroid dose Oct 26, 2007

Hello,

Although long-term use of immunosuppressive agents, such as corticosteroids, can affect HIV-antibody-test results, this would cause a false-negative result, rather than a false-positive result. The reason for this is that corticosteroids can suppress the body's ability to make antibodies, including anti-HIV antibodies. Consequently, someone who is HIV positive and on significant corticosteroids could test HIV negative (false-negative). Corticosteroids also would not affect HIV PCR RNA viral load test results.

Having said that, is there any way your test result could still be inaccurate? Yes, absolutely. You report that your wife is confirmed to be HIV negative and that you have had essentially no risk exposures monogamous since getting married and minimal sex before marriage, all of which "safe sex." Assuming that you are not an IV drug user who shares syringes and have not received a blood transfusion of HIV-tainted blood, you have essentially no risk. Consequently, your recent positive test is inconsistent with your potential risk. The most likely cause for this is not your congenital adrenal hyperplasia or use of replacement steroids, but rather a technical or clerical error. Someone could have mixed up the samples or your results. I would suggest a repeat ELISA test and, if positive, a confirmatory Western Blot as your next step. If those are again positive, a repeat HIV plasma viral load and visit to an HIV/AIDS specialist should be scheduled. The specialist will review all the lab results, your personal medical history and your current medications. If needed, he will order additional tests to clarify your status.

I'm sending you my very best good-luck/good-health karma that your follow-up tests prove that your initial tests were in error! Keep me posted! I'm here if you need me, OK?

Good luck!

This is your answer to me long time back

I consult endorcinlogist he suggest that long period of using prednisone might interfer in my HIV tests then I reduced the dose into 6mg daily my CD4 increase from 540 into 690 then PCR from 56400 into 30000 but WB still positive then after 6 months i reduce the dose into 4mg and wait for one months then tested WB still positive and PCR become undetectable ( surprise ) My wife pregnant in 5th months in our third baby she still negative

[Please advise me as i consider myself havea false positive HIV caused by steroid , I read most of www.thebody.com archeives I conclude there is no cut off point in steroid affect in HIV tests ( antibodies ) and I have to consider the negative result of my PCR to move on in my life before one week I visited another consultant in infectios dieseas i told him my story since one and half year and he made a phisical check in my body and he told me that 99% you are suffering from long term use of steroid and this creat false positive HIV antibodies and you have to do another tests after 6 months to monitor your result especially after changing my mediecine from 4mg of prednosone into 20mg of hydrocortisone because hydrocorisone better in short acting dose .

Please advise Is passing sucssefully the phisical exam and Negative PCR is the final approve of not holding HIV

Thanks

Response from Dr. Frascino

Hello,

My opinion hasn't changed. Corticosteroids can suppress immune responses and might cause a falsely negative HIV test by suppressing the immune system's specific anti-HIV antibody production. Corticosteroids should not cause a false-positive HIV antibody test, although a number of other things can. You can read about these in the archives. Also "false positive" HIV antibody test results would not explain elevated HIV plasma PCR tests, which have absolutely nothing to do with anti-HIV antibodies! As I mentioned in my initial response, you have essentially no HIV risk from what you've told me. Consequently your positive test result was inconsistent with potential risk, thereby suggesting it was indeed falsely positive. Your results are still a bit of a conundrum, due to the two significantly elevated PCR tests. Without the benefit of actually reviewing your entire medical file and related test results, I can't offer a concrete explanation. However, an HIV specialist or clinical immunologist most likely would be able to sort this out for you by reviewing your chart and results in detail. I do agree with your recent infectious diseases doctor that your chances of being HIV positive are essentially nil.

Dr. Bob



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