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Help. Trying to deal with this for 6-years (POSITIVE ELIZA AND NEGATIVE WESTERN BLOT)
Apr 19, 2008

Dear Dr Bob,

I had spent the last 6 years of my life trying to deal with this problem of mine and had gotten nowhere. I have consulted numerous physicians - ID, haematologist, respiratory specialist, neurologist, spent considerable amount of money and yet getting nowhere. In fact, it has gotten worst. I understand its not your practice to diagnose patients online but I hope you could offer some advise on where I should be heading. Below is a chronology of events:

Prior to 2002, I had paid for sex for several ocassions - vaginal and oral. All with condom, except oral sex.

Mid of 2002, I went for hiv test. My elisa came back positive. The hospital went on to do a western blot and gladly it came back negative - "no band found". Since then, I had stayed monogamus (wife), no more sexual risk factor.

Mid 2004, I went for another hiv test. The result were similar to the earlier tests - elisa positive, wb negative.

Late 2004, for some stupid reason, i had unprotected vaginal and oral sex with a casual friend, of which I am not sure of her hiv status. I know it was an unresponsible act, I guarantee it will never happen again.

From Dec 2004 till today, I have stayed monogamus.

Early 2006, I started to notice my gums were receding. Dec 2006, my gums were starting to hurt.

In Jan 2007, I went to do another hiv test. The result were similar, elisa positive and wb negative. My gum problem got worst. In addition to pain in my gums, the roof of my mouth and cheek were feeling pain as well.

In Dec 2007, I decided to do another hiv test. Again, elisa was positive an wb negative. Details of the test: HIB Ag/Ab Combo (ARCHITECT) - non-reactive Anti HIV 1/2 Antibody(AXSYM) - reactive HIV 1/2 Rapid Test - non-reactive HIV 1/2 Particle Agglutination (PA) - non-reactive Western Blot - non-reactive I went on to do a cd4 count and result was: cd4 abs count 550, cd4% - 28%, cd4/cd8 - 0.8

In Jan 2008 - I did a RNA PCR (COBAS TaqMan HIV-1 Test) and result was non-detected.

Based my tests, one would think I have a false positive result. However, my body is presenting conditions which are signatures of hiv. I have - gum pain which looks like LGE - gum recession - general problems with upper repiratory - swollen sinus, chect tightness, panting (respiratory tract infection) - pain along the neck collar bone (lymphnode area) - i also did a ct scan of my neck 2-weeks ago and they found cervical lympadenopathy (3 on each side)

I've also done other tests - mold, allergy, mineral deficiency (zinc, calcium, selenium, etc). With the exception of elevated allergy to dust mite, everything else is within normal range.

1. Would it be possible I might still have hiv virus? Any other tests I should do to rule out the possibility I might have hiv? Could I have missed out other tests for other types of HIV virus? 2. Is it possible that i do not have the antibody but yet have hiv virus? 3. I'm of the opinion that my health conditions are caused by my somewhat low cd4 count. Does my condition look to be idiopathic CD4? 4. Any advise where I should head to get some help?

Thanks in advance!

Response from Dr. Frascino

Hello,

Yours is yet another all-too-common and unfortunate story of lack of information about and understanding of HIV test results leading to unnecessary testing and resulting in unnecessary anxiety. This could have all been avoided if someone had explained to you that a positive (reactive) ELISA followed by a negative Western Blot is considered to be a negative HIV-screening test! Period! Chances are at least one of the multiple physicians you've consulted (most likely more than one) has told you exactly that. Continuing to repeat the test produced (not unexpectedly) the same result: You are HIV negative! Basically I think you probably don't understand the two-level HIV-screening system. Both ELISA and Western Blot tests check for the presence of anti-HIV antibodies in the blood. The ELISA is a more sensitive test and therefore will pick up more falsely positive results. The confirmatory Western Blot is the more specific test and therefore is more likely to produce more false-negative tests. By combining the ELISA and Western Blot we are best able to identify true HIV positives.

Your CD4 counts were normal (not unexpectedly) and your RNA PCR was undetectable (again just as would be predicted). Neither of these tests was warranted. Nor did they give you any additional information.

Therefore you now have overwhelming, irrefutable and highly excessive evidence that HIV is not your problem. No way. No how.

As for your "body presenting conditions which are signatures of HIV," I strongly disagree. Your symptoms are not consistent with HIV acute retroviral syndrome (ARS).

To address your specific questions:

1. No, absolutely not. No additional tests are warranted. You've had way, way, way too many already. What part of "HIV negative" don't you understand?

2. No, absolutely not.

3. No. Your absolute CD4 count is normal. You do not have ICL (idiopathic CD4 lymphocytopenia).

4. Yes, absolutely! You need to seek psychological or psychiatric help to address and hopefully conquer your irrational and completely unwarranted fears of being HIV positive. The psychologist/psychiatrist could also help you accept the wonderful news that you are HIV negative.

Good luck.

Dr. Bob



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