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Negative Elisa and reactive p24
Mar 3, 2008

I am a nervous wreck.I am a 26 year old male. On December 30, 2007, I have unprotected sex with a person who I now understand is HIV positive. We both engaged in anal sex and he ejaculated in me and I ejaculated in him. We also rimmed each each and engaged in oral sex. He states now that he is 33 and has been HIV postive since he was 15. He states that he is on medication and that his viral load is undetectable. (I have read that viral load tests the HIV load in the blood and not necessary the HIV load in the prostate gland or some gland or membrane in the rectum. With that said is it true that the HIV virus could be present in these two areas even if the HIV viral load in the blood is undetectable.) On the 11th day after we engaged in the unprotected sex my doctor did an RNA tests as well as an ELISA and Western Blot test. He advised that all cam back negative. How accurate is the RNA blood tests on the 11th day after an exposure? Now eight weeks later to the day, he does another ELISA tests and it comes back negative, however, the Western Blot test comes back with the P24 as showing reactive. While my physician has stated that the test is indeterminate like I said earlier, I am a nervous wreck. It did not help that whenI asked the physician his gut feeling, he did say that he could understand why I was concerned and if it was him he would surly have a lump in the back of his throat. I am going back tomorrow at the nine week mark exactly to have a retest done. With all of that said, I have several questions. In your opinion, has enough time passed based on the type of tests done to determine if I am HIV positive? It is my understanding that the first band to appear is the 24 band. How concerned should I be that this band has appeared at the 8 week mark and does it probably mean that the other bands will soon follow as I may just be beginning to servoconvert? What other tests could I ask my doctor to perform so that I could get some immediate results -- good or bad at this point, the nine week mark? In clsoing, whta is your opinin? Do you think I am HIV positive or that in the weeks ahead the ELISA test and the WEstern Blot tests will change from negative on the ELISA to positive and from inderminate on the Western Blot test to postive. Thanks very much for your thoughts and I look forward to a response.

Response from Dr. Frascino

Hello Nervous Wreck,

Agreed: Unprotected sex does place you at some degree of risk for STDs, including HIV. And testing is warranted.

However, your current physician is certainly not doing you any favors and please feel free to let him know I said so. He is ordering improper tests at improper times and not interpreting the results correctly!

First a few facts:

1. The proper test for HIV screening is an HIV-antibody test (ELISA, rapid test or equivalent). If this initial screening test is repeatedly reactive (positive), then and only then should a confirmatory Western Blot test be ordered.

2. HIV-antibody tests taken prior to the three-month mark are not considered to be definitive or conclusive.

3. HIV RNA PCR tests are not recommended for routine HIV screening, due to the rate of false-positive results, other technical considerations and cost.

That said, you've had a number of tests run inappropriately. Your two ELISA tests (11 days and 8 weeks) are both negative. This is encouraging, but not definitive. The Western Blot with a single p24 band is not interpretable, because it means nothing without a preceding positive ELISA. The negative RNA PCR is an inappropriate test, but nonetheless is negative.

I see no reason for a lump in the throat or concern based on your laboratory tests to date. What is of concern is your current doctor's competence (or lack thereof) in appropriately screening for HIV disease!

Here's what you need:

1. An ELISA (or rapid test) at the three-month mark. If negative, get a follow-up ELISA (or rapid test) at six months. If that remains negative, you have definitively dodged the HIV bullet.

2. If your three- or six-month ELISA or rapid test is reactive (positive), get a follow-up confirmatory Western Blot.

3. A more competent physician!

Good luck!

Dr. Bob



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