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I am a nervous wreck! (INDETERMINATE )
May 5, 2008

Dr Bob,

I recently had an HIV test. One week later I was called back to the office for my results. My OBGYN stated that i tested positive for HIV and that the results from the 2nd test were Indeterminate. I am so confused and my partner was just tested about 3 months ago and the results were negative. When looking at my lab results, my gp40 showed to be "equivocal" and my g24 was present. Everything else was absent.I am to have further testing this coming monday. During the time that my test was taking, I was suffering from a bacterial infection, of which since I have been treated. Would this have anything to do with my "indeterminate" status? Please shed some light if you can. I am extremely nervous!

thanks, Scared to Death

Response from Dr. Frascino

Hello Scared to Death,

This type of problem comes up almost on a daily basis in this forum. (Check the archives!) Your OB/GYN was wrong to advise you that you tested "positive for HIV." A reactive (positive) initial HIV-antibody test with an "indeterminate" follow-up test (most likely a Western Blot test) means your entire HIV screening is "indeterminate," not positive!

There are many causes for an "indeterminate Western Blot" test. See below. Write back if you remain confused after reviewing this information and obtaining your follow-up testing. If your true risk for HIV is nonexistent, your chances of being HIV infected are also nonexistent.

Good luck.

Dr. Bob

Indeterminate Test Results (INDETERMINATE WESTERN BLOT) Apr 29, 2008

Within the last year I cannot think of any one thing that would make myself 2nd guess anything I've done in my life to even think I have HIV. I've had a swollen lymph node for 2 months now and finally got to a doctor to have it checked out. He had me tested to HIV. Yesterday, I went in to discuss the results with my doctor and he said that I may have HIV. The Western Blot test revealed that gp40 and p24 are present. There was another test, HIV 1/0/2 Abs-ICMA that showed 1.78 (HIGH). I have done nothing risky, my husband and I have been completely faithful to each other for the 3 years we have been together. I'm terrified, worried, and confused. I don't know what half of these results mean and I'm not sure what could have caused me to have HIV in the first place! Please, any and all advise will be greatly appreciated. Thank you.

Response from Dr. Frascino

Hello,

This type of situation is becoming a QTND (question that never dies) and like all QTNDs has an ATNC (answer that never changes). The information you need and reassurance you desire has been waiting for your double click in the archives. (See below.)

Briefly, the antibody (Abs) test is the preliminary screening test and that revealed a "HIGH" result (presumable reactive or positive result). This should, and did, trigger a more specific confirmatory test (the Western Blot), which has come back as "indeterminate." Please note, indeterminate does not mean positive! It means the test can't quite determine if you're negative or positive. Certainly if you've had essentially no HIV risk, there is essentially no way you could be HIV positive and your tests will eventually confirm this.

Your next step should be to repeat your HIV-screening tests. If you again get an indeterminate result, you should then get an HIV DNA PCR qualitative test. The HIV DNA PCR qualitative test is not routinely recommended for HIV screening, but can be helpful in sorting out unclear or indeterminate HIV-antibody results. HIV DNA PCR testing does not utilize anti-HIV antibodies, but rather detects a piece of genetic material from the HIV virus itself.

Good luck.

Dr. Bob

Indeterminate Results Apr 16, 2007

Hi Dr.Bob, I had a reactive Elisa test done and and Indeterminate WB with P26 band present. I have not had any exposure in over 12 years before I married and my wife is nonreactive on Elisa. Does indeterminate mean I am HIV+ and can the Flu cause this kind of results?

Response from Dr. Frascino

Hello,

Another QTND (Question That Never Dies). See below and then check the archives for additional detailed information related to this common conundrum.

Please note you are most likely HIV negative, based on nonexistent risk and an indeterminate WB. Subsequent testing should confirm my very strong suspicion that your ELISA test is a false-positive. The "flu" would not cause these results, but there are many other potential causes.

Dr. Bob

inderminate WB test (INDETERMINATE WESTERN BLOT) Feb 9, 2007

I tested positive in teh ELISA test and have an inderminate result in the WB test. In my opinion, I am a low risk person. In the past 3 years, I have had unprotected sex with 2 different guys, one being in the military, who has tested negative and one who was married for 10+ years before me. I am unsure what bands showed up on my WB test. What is the percentage of an inderminate WB test turning into a positive HIV test? I was told I could not get tested again for 3 months and I have asked my 2 recent sex partners to get tested.

Response from Dr. Frascino

Hello,

Indeterminate Western Blot tests account for 4% to 20% of Western Blot assays in various studies. The causes of indeterminate results include:

1. Serologic tests in the process of seroconversion; anti-p24 is usually the first antibody band to appear.

2. Late-stage HIV infection, usually with loss of core antibody.

3. Cross-reacting nonspecific antibodies, as seen with collagen-vascular disease, autoimmune diseases, lymphoma, liver disease, injection drug use, multiple sclerosis, parity or recent immunization.

4. Infection with O strain or HIV-2.

5. HIV vaccine recipients.

6. Technical or clerical error.

The most important factor in evaluating indeterminate Western Blot test results is risk assessment. Patients in low-risk categories with indeterminate tests are almost never infected with either HIV-1 or HIV-2; repeat testing often continues to show indeterminate results and the cause of this pattern is often not elucidated. For this reason, it's important to realize that HIV infection in situations like yours is extremely unlikely, although a follow-up test in three months is recommended to provide absolute assurance. Patients with indeterminate tests who are in the process of seroconversion usually have positive Western Blots within one month. DNA PCR may also be helpful for sorting out indeterminate serologic test results. An HIV specialist can help assess your HIV risk and interpret HIV test results if necessary.

Good luck.

Dr. Bob



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