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UPdate 3: to May 19, multiple inclusive report
Jun 23, 2008

Hello again Dr. Bob,

I don't mean to bug you again. I will follow your advice. The only reason why i haven't is because the Doctor I went to is also HIV positive and also listed as a provider on AAHIVM website and I felt he would be able to diagnose me properly. I actually saw him Friday June 21 to rediscuss my results and he said the 2nd WB showed all the positive bands were present - confirming my positive status. The first WB only had 2 band present.

NOw in looking at AAHIVM site, he is only listed as an MD, the other 2 doctors I am considering are MD, AHIVS, and the other is MSN, APRN, BC, ACRN,AAHIVS. NOt sure if all of those acronyms matter. I do know, however,is that my doctor had to call another specialist to discuss my results after he told me I was negative to let me know a week later I was positive. Given all of the above, AndI realize you are at a disadvantage without my past lab work to review, should I still go to another doctor(one of the other two I mentioned) and get the qualitative PCR test. Also, out of curiosity, do you still accept patients, I would love to have you review my situation, personally as an option. I've actually told my immediate family of my situation, and like you want me to get retested. As always, Thank you for your advise and for being so direct, I greatly appreciate it.

UPDATE to May 19, Multiple Inclusive report Jun 21, 2008

Hell again Dr. Bob,

I wrote to you back in May about my inconclusive test and you were awesome and replied to my questions. I appreciated that IMMENSILY.(past questions below). I need to tell you that your email was extremely helpful in controlling my STRESS before I got tested again. Well I got the results last Thursday, May 12, and my doctor told me I was negative, my resutls in April were Negative elisa, Indeterminant WB and PCR 62 to a PCR(hiv-1 RNA, ultra) , PCR <= 48 and based on the New PCR reading my doctor said i was negative..WOO HOOO I said. My doctor didn't have my elisa and WB results yet. I was happy with the negavite results. Well, today my doctor called me in with the Elisa and WB, Results- both came back positive and my doctor now says I am positive!!! ( I felt like I just hit a brick wall. I don't know what to make out of the results from being negative one week to a positve the next. In case you are wondering, my CD3 is 2263, CD4 1132, CD8 1066, DC19 314, CD16+CD56) 23.5., I assuming that by looking at report the P18, P24, p31. I take full responsibilities for my actions, I apologize for making this letter, but can you please frovide some feedback, suggestions, i am positive? Thank you,

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

Hi,

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.

Good luck.

Dr. Bob

Response from Dr. Frascino

Hello,

Your situation continues to be complicated by excessive inappropriately ordered tests that produced results that are nearly impossible to interpret. PCR RNA and CD4 subsets are not helpful or appropriate when you have not even established your HIV serostatus! Whatever physician is ordering all these tests for you is certainly not doing you any favors. My advice is simple:

1. Consult an HIV specialist to ascertain your HIV serostatus and, if necessary, to proceed with further evaluation and management. You can find a certified HIV specialist in your area by checking the American Academy of HIV Medicine's Web site at www.aahivm.org.

2. Stop any further testing until guided by an HIV specialist. At this point, I cannot clearly ascertain your HIV serostatus, but it will not be difficult to sort all this out by carefully reviewing your history, test results to date and supplementing those as needed with appropriate diagnostic follow-up tests. If there is ongoing confusion or if your serologic tests are in dispute, a qualitative PCR DNA could be considered.

I do hope this time you'll follow my advice.

Good luck.

Dr. Bob

Response from Dr. Frascino

Hello,

Yes, I would recommend you seek a completely independent second opinion from a certified HIV specialist. After reviewing your entire record, he or she will advise whether a qualitative PCR DNA test or other evaluation is warranted. Accurately determining HIV serostatus is not difficult when the appropriate tests are ordered at the appropriate time and in the appropriate order and are then properly interpreted. The HIV specialist will know what more, if anything, needs to be done for your evaluation.

The Frascino Medical Group (phone number 650-917-1357) does accept new patients on a limited basis.

Good luck.

Dr. Bob



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