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ELISA POSITIVE AND NEGATIVE WESTERN BLOT
Sep 30, 2008

I READ AN Q&A YOU DID CONCERNING ELISA FALSE POSITIVES AND A NEGATIVE WESTERN BLOTS. I WAS IN THE EXACT SITUATION AND MY VIRAL LOAD CAME BACK AT 99,000 WITH A NEGATIVE WESTERN BLOT. MY ID DOCTOR WAS A BIT CONFUSED BECAUSE MY VIRAL LOAD SHOULD HAVE BEEN HIGHER IF THIS WAS IN FACT AN ACUTE INFECTION (I HAD ACUTE HIV SYNDROME WHICH INITIATED THIS WHOLE PROCESS). THIS WOULD HAVE EXPLAINED THE NEGATIVE WESTERN BLOT DUE TO THE FACT THAT I WAS STILL SERO CONVERTING AND HADN'T PRODUCED ANTIBODIES. SO, WHAT THE HELL? LOL I HAVE BEEN UNDER HIS CARE FOR OVER A YEAR NOW. MY VIRA LOAD IS NOW 15,000 AND MY CD4 IS 820 - SO NO MEDS FOR ME YET. I GUESS I DON'T QUITE UNDERSTAND WHY THE WESTERN BLOT WAS NEGATIVE. I POSED THIS QUESTION TO HIM AND HE SAID IT WAS IRRELEVANT BECAUSE I HAD A VIRAL LOAD AND THAT WAS CONCRETE PROOF OF INFECTION. I AM FINE AND I HAVE ACCEPTED THE FACTS, BUT READING THAT QUESTION AND YOUR ANSWER THAT A NEGATIVE WESTERN BLOT WAS CONCLUSIVE CONCERNING NONINFECTION PROMPTED ME TO PICK YOUR BRAIN FOR A MOMENT. I LOOK FORWARD TO HEARING YOUR RESPONSE. THANKS FOR YOUR TIME.

DALE

Response from Dr. Frascino

Hello,

I'm not exactly sure which question you are referring to. I believe it is the one posted below, although it did not involve Western Blot testing.

In your case, you were experiencing "acute HIV syndrome" and your HIV plasma viral load was moderately elevated at 99,000. That's quite different from the other questioner who only had a 20,000 viral load. However, even in your case, if you indeed have never had an HIV-antibody test outside the window period, I would suggest you get one! It's an inexpensive test and should be part of your medical record. You should have an ELISA (or EIA or rapid test) and if reactive (positive), a follow-up confirmatory Western Blot test.

Good luck.

Dr. Bob

False Positive Sep 28, 2008

Hello. First, I would like to thank you for a great website. Your content, ease of use and dedicated honest questions i'm sure have helped thousands in the understanding of HIV/AIDS.

In February of 2006, I went to a local clinic to get tested for HIV. My HIV occurance happended sometime in the month of January/Early February of 2006. I had flu like systems in February of 2006. On March 9, 2006 the local health department called me to let me know my result was positive. The RNA test had returned positive, while the elisa test returned negative. They immediatley provided care at the doctors office and they began me on Sustiva/Truvuada.

I have now been on Sustiva/Truvada (switching over to Atriplia) from March of 2006 to the present. My cd4 count was 500 with a viral load of 20,000. The following month, of April, 2006, my viral load was undetectible. My viral load has always remained undetectible with a cd4 count averaging 600.

This week, I went and got a oralquick HIV test just (09/23/2008) and the test result was negative. Confused, I was.

To confirm, I went and got another HIV oralquick test on (09/25/2008) which I made they perform two tests on me at the same time. Both of those tests came back Negative.

My question of disarray is i'm positive or negative?

I do not know if the treatment center ever did a confirmation test on me. I always assumed they did.

Additionally, could of the medicine, for lack of better words, "cured" me?

Why was there a viral load in the beginning and a lower than my average of CD4 count?

Thanks for your assistance.

Response from Dr. Frascino

Hello,

A clinic told you that you were HIV positive based on a PCR RNA test that showed a low HIV plasma viral load and a negative ELISA test!!! YIKES!!!! I can only assume that the clinic felt you were undergoing acute retroviral syndrome (ARS) and were still within your window period (defined as the first three months after primary HIV infection). That is the only scenario that could account for their advising you that you are HIV positive despite having a negative ELISA. However, because HIV PCR RNA tests have a significant rate of false-positive test results, especially at low viral loads, they certainly should have followed up with confirmatory HIV-antibody tests once you were out of your window period. That you have now have had three separate negative rapid tests out three years from your "diagnosis" indicates your initial HIV positive diagnosis may have been (and probably was) wrong. I would strongly advise you have an evaluation with a competent HIV specialist to sort this situation out definitively. If you need help locating a certified HIV specialist physician in your area, check the American Academy of HIV Medicine's Web site at aahivm.org. There you will find a roster of certified HIV specialists listed by locale.

Could the medicine have "cured" you? No, unless you believe in miracles. The much more logical explanation is that your initial HIV PCR RNA was a false-positive.

Write back and let us know how this all settles out. It's an excellent lesson for our readers and a clear demonstration why I consistently advise that HIV PCR RNA (or DNA) should not be used for routine diagnostic screening!

Good luck!

Dr. Bob



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