Multiple inconclusive tests
May 19, 2008
Hello Dr. Bob,
I am currently stressed and scared with my indeterminant hiv tests. On April 19, I went to a Walk in clinic and underwent an STD check up. Well, everything came back fine with the exception of an indeterminant HIV test- the clinic told me the Elisa was positive but the Western Blot was indeterminant. Well, the day I got the result (April 23) I rushed to another clinic and had a rapid test that came back negative- it calmed me down a bit. Well, on April 25, I went to see my personal doctor and informed him of the situation. He ended up performing another Elisa and did a PCR. The Elisa came back negative and the PCR came back with a 62 reading. My doctor informed me that reading was too low to conclude anything and was thus inconclusive and recommended that I get retested in 6 weeks (June 9). Well, 2 weeks later(may 11) i flew back home and decided to get retested- I got a rapid test that came back negative and an Elisa that came back positive- The clinic I went to is currently doing a western blot and is aware of my indeterminante status. I know I am being impatient with all of the testing, but can you please provide some insight on what might tbe going on with my negative rapid test, positve/negative elisas, indeterminant western blot and PCR of 62. I read somewhere that the hepetatis vaccine might affect the resutls of these tests and I was administered the vaccine a few years ago. Your help will be greatly appreciated. Thank you, Also, I did have two unsafe experiences one in February and one in April were the guy penetrated me for a few seconds without a condom before he put one on.
Response from Dr. Frascino
You have two related problems, both of which could have been easily avoided and both of which you are directly responsible for:
1. Two unsafe experiences;
2. Way too many tests run inappropriately.
For problem #1, I assume you now realize the potential catastrophic consequences of unsafe sex are not worth the risk of going commando Rambo without protection, right?
Regarding your negative rapid tests, positive/negative ELISAs, indeterminate Western Blot and PCR of 62, all of this could have been avoided if you followed recommended guidelines for testing. Taken in total I strongly believe you are HIV negative. In order to sort it all out I would recommend you get a qualitative PCR DNA test. (You had a quantitative PCR RNA that gave you a very low reading of 62, which is most likely falsely elevated.) The qualitative DNA PCR is not recommended for routine HIV screening, but can be helpful in sorting our unclear or indeterminate antibody tests. If it is negative, as I predict it will be, you should stop testing and yell WOO-HOO! More than likely you have a nonspecific cross-reacting antibody, which is causing your intermittently positive anti-HIV antibody test results. If you continue to test you may well continue to get confusing HIV-antibody test results. So the best option is to confirm your negative status with the more sophisticated test that doesn't rely on anti-HIV antibodies and then use safer sex techniques so you won't have to endure all the drama again in the future.
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