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indeterminate hiv
Jun 18, 2008

My question is this. A couple of years ago, my family physician recommended i have a full work up done on my blood because my white blood cell count seemed to be low everytime i went for a checkup. He sent me to a blood specialist who ran a series of test including hiv. Everything came back fine except the western blot came back indeterminate with an "equivocal" amount of p55 and no other bands present. One month later they ran another Wb and it came back indeterminate again with p24 "present" and no other bands showing. About 30 days later, i had the highly detailed test done(I think it was called a PCR,very expensive test from what i remember,around $700.00) and it came back negative.My doctor said i am hiv negative. I am getting ready to buy life insurance from my friend and i would hate to go through the embarassment of the hiv test coming back indeterminate and having to explain that to my buddy. I am heterosexual. A year before these test i tested negative for HIV. My wife tested negative and we have a beautiful little girl. I was diagnosed with HSV-1 years ago (cold sores)Do you think the herpes virus could have caused these indeterminate results from the hiv testing? Do you think the screening for the life insurance policy will come back indeterminate? Thanks.

Response from Dr. Frascino

Hello,

I'm a bit confused. You report the blood specialist ran a series of tests and everything came back fine except the HIV Western Blot, which returned with an indeterminate due to an "equivocal" p55-protein band. Was the Western Blot being run as a confirmatory test after a repeatedly reactive (positive) ELISA test? If not, it means essentially nothing! Western Blot tests should only be run to confirm a preliminarily positive ELISA (or EIA or rapid test). Running a Western Blot (WB) without a screening ELISA will result in anywhere from 4% to 20% "indeterminate" results! This can be due to a variety of reasons, including the presence of cross-reacting nonspecific antibodies.

You then report that one month later they ran another WB, which came back indeterminate; this time with a p24 band present. I have the same question/concerns as with the first indeterminate WB result. Was as preliminary ELISA run first and was that test positive?

Your follow-up HIV PCR was most likely an unnecessary expense. We don't recommend PCR testing for routine HIV screening due to the number of false-positives, other technical concerns and cost. The negative (undetectable) result merely corroborates what I assume you should already have known, if your HIV tests were ordered and interpreted properly. If you had a negative rapid test or ELISA, that's all you would need to confirm your negative HIV serostatus. You can have this done now if not already done.

Regarding HIV screening for insurance purposes, they will run an HIV-antibody test, such as an ELISA or rapid test. If negative, that's as far as they will go. If positive, they'll either deny your claim or go on to run a confirmatory WB or IFA (immunofluorescence assay). They will never run only a Western Blot; neither should any physician or testing site!

Dr. Bob



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