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Re: So Scared.....
Feb 10, 2009

Hi Doc,

As per your suggestion, I took the advice of an HIV speacialist regarding the positive PCR test results.

He told me that I should not have used this test for diagnostic purposes, but since I had opened this can of worms, I should use the correct procedure to determine if it was indeed ARS I was experiencing. Hence I was advised to take the HIV PCR RNA Quantitative Test followed by normal HIV serological tests (i.e. antibody) at 3 months.

The results are as follows:

Test (18 days post exposure): Quantitative RNA estimation of HIV from patients plasma

Method: Real Time PCR (SDS)

Probe Used: 30 base pair long dual labeled oligonucleotide TaqMan probe

Equipment: Rotorgene from Corbett Research, Australia

Subtypes: All common HIV 1 subtypes

Sensitivity: 53 IU/ml

Conversion: 1 IU/ml = 1 Copy/ml

Measuring Range: 53 to 3,571,428 IU/ml

RESULT: Below 53

Log Value: Not applicable

They also re-ran the the qualitative PCR RNA test with the sample of blood they had kept frozen and the results were NOT DETECTABLE. The method used was RT-PCR and the equipment was Rotorgene from Corbett Research, Australia. Analytical sensitivity was 53 IU/ml.

Do the results above indicated that I am not infected by HIV? They have not given any explanation why the first results were positive....

Learnings:

1. Never use PCR for testing for HIV! Use the standard antibody test at 3 months.

2. Never put yourself in a situation like this if you cant handle the consequences.

Do you think I will be able to woo-hoo in mid april when I take the proper tests?!

Thanks!!!

Thanks!

Response from Dr. Frascino

Hi,

I agree with the HIV specialist! HIV PCR RNA tests should not be used for routine diagnosis. Your test results are definitive and conclusive. You are HIV negative. HIV is not your problem. No way. No how. Yes, I have no doubt you are WOO-HOOable!

Dr. Bob

So Scared..... Feb 4, 2009

Hi Doc,

I was just informed that my qualitative HIV PCR RNA test was positive and my antibody was negative. They said they saw signifcant level of HIV.

My only exposures were Jan 1 and Jan 18. The former where I received multiple unprotected blowjobs and the latter the same, but I als engaged in deep kissing with cuts in my mouth and some rubbing. She did play with her vagina so perhaps she also had some fluids on her hands. I dont know but I thought the risk for this was non-existant. I did also use a clotrimazole and steroid cream on my penis for 4 days before the second episode due to a fungal infection so maybe the skin was compromised. And she did use cocaine on her tongue. So many variables, so I dont know what the risky part was.

Bottom line is that my hopes are now pinned on the PCR result being a false positive. What are the chances in your opinion?

3 days after the second episode I did experience ARS symptoms like nausea, pain in the groin/armpit/neck, feeling unwell, and stomach pain the first day. I also think I lost weight cause I was eating so much junk and losing weight. I attributed this to a reaction with the doxy and cefixime I was taking at the time.

I thought the risk was very low and the ARS symptoms started too early. But it looks like I was wrong?

Response from Dr. Frascino

Hello,

Despite your many variables, your HIV-acquisition risk would still be considered low. Why was an HIV PCR RNA test ordered? It's not recommended for routine HIV screening. (It can be helpful in selected cases where there is strong clinical suspicion of active seroconversion. In this case the HIV-antibody test could still be negative.)

Regarding HIV RNA PCR tests in general, false-positive tests occurred in 2% to 9% in some studies. False positives are most commonly seen at low viral load titers (less than 10,000 copies per milliliter). The sensitivity of RNA PCR approaches 100% in confirmed cases of acute HIV infection. The specificity of the test is 97% but improves to nearly 100% when the viral load is greater than 10,000 copies per milliliter.

If you're freaking out about your results, see an HIV specialist physician. He should be able to sort out the confusion most efficiently. Write back and let us know how this turns out. And please include the results of your follow-up tests.

Good luck.

Dr. Bob



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