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Confused
Nov 14, 2008

Hi. I'm a 26 year old healthy gay male. I had an exposure last June. The condom broke and was then informed my partner was poz. I was bottom. First thing in the morning I called my doctor who consulted with the leading HIV clinic in my area and was put on PEP for 28 days. The PEP consisted of Kaletra and Combivir (not a plesant combination of drugs).. but I made it through and finished the 28-day regimen in the end of July i tested negative at the end of August (Oraquick saliva sample and an Elisa/ Western Blot from one sample). Three weeks ago (beginning-ish of October) I went back to the clinic for another round of tests. I have had no possible exposure since the June incident. My Oraquick 15 minute test came back negative. The blood work takes three weeks to come back (its a free clinic and the sample is sent to the state for processing). I got the call on Friday to come in and knew that it was not good. Both my elisa and western blot came back reactive. The clinic administered another Oraquick test with a saliva sample and it came back negative! They wouldn't do another blood test (Im not exactly sure why) but they went ahead and did a viral load test and they're going to call me when the tests come back to come in for intake and discuss meds. The viral load blood test will take a week to come back as opposed to the three weeks waiting period for another hiv test. They were confounded by the double negative Oraquick test and made certain that the second Oraquick I received was from a different lot/shipment than was the first. After leaving the free clinic I went to my primary healthcare physician and they gave me another elisa/western blot test that should be back within a week. They, too, were confounded by the negative Oraquick. I then went to the local hiv/aids nonprofit where I frequently volunteer and received counseling (I was a bit of a wreck obviously). They told me that they had seen several cases where an Oraquick would either give a false positive or detect HIV *BEFORE* the elisa/western blot tests do. (ie its too early in the window period for the elisa/blot to detect but the oraquick is so sensitive it picked it up). They've never heard of a double oraquick negative but positive elisa/blot... Obviously, I'm freaking out here a bit (but luckily the nonprofit helped pull me off of the cloud I was on and back to reality)... I know all I can do is be patient and wait for the second elisa/blot tests to come back. Have you ever heard of this? The exposure is a little over three months ago. Any insights you can give would be greatly appreciated. Thank you.

Response from Dr. Frascino

Hello Confused,

You tested ELISA/WB negative two months after your exposure (one month after a full 28-day course of Kaletra/Combivir PEP) and then tested OraQuick negative a month after that. That all that makes sense. However, at the three-month test where you got the negative OraQuick test, your ELISA and Western Blot results came back "reactive" and an additional oral fluid OraQuick test was again negative. I can certainly understand why you are confused! I am as well. There are several possible scenarios here:

1. You seroconverted within the six-month window period, despite PEP. PEP is not 100% effective, even when appropriately prescribed and taken. (Yours truly is an excellent example of that!) However, this would mean that two OraQuick tests from two different test lots on two separate occasions were false-negative tests. This would be extremely unlikely. Another possibility would be that both OraQuick tests were subject to technical or clerical errors. Again, the statistical odds of this occurring are so remote they become essentially nonexistent.

2. A second, more likely scenario would be that the positive ELISA and Western Blot were false positives. There are several potential causes of false-positive HIV tests. You can review that information in the archives.

I'm glad you have other tests pending, including a repeat ELISA/WB ordered by your primary care physician and an HIV plasma viral load at the free clinic. These results should definitively clear up any confusion about your HIV serostatus.

If I had to be bet on how this would all turn out, I would place my wager on your being HIV negative. Write back and let us know the final result. We'll all keep our fingers crossed, hoping your conundrum was the result of a false positive rather than two false negatives.

Good luck.

Dr. Bob



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