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Need help .. (USING HIV RNS PLASMA VIRAL LOAD FOR ROUTINE DIAGNOSTIC HIV SCREENING)
Feb 16, 2009

Hi Doctor,

Greetings!! You and your team is doing great job!! Thankyou.

I am from India. My case was never a risk but i made it complex.I went to a massage parlor, got normal body massage, used the massage towel to clean the oil which floated on to my organ from naval region.Nothing else. My doc told there is zero risk of hiv transmission with this scenario. But anxiety and negative thoughts of semon or blood on towel forced me to go for tests - 3rd week ELISA - negative. Then my doc suggested to go for viral load test seeing my anxiety to make me relax. They did quantitative PCR viral load test (RT-PCR) -[Taqman's and FLUORESCENT technique] on 32nd day and surprisingly it detected hiv-1 in the assay. It said 1,000,04 IU/ml and also said note: The reports results are not conclusive as the sample can be spoiled during transportation.For this test the sample was sent to different city and it took 11 days to get the result. It was terrible shock and shook my life. My doc suggested Western blot test and CD4 Test at 7 week. Exactly on 48th day, I went for WB test which came completely Negative with No Bands. My cd4 count is 756(lab range 350 - 1050).Doctor please help me to understand the results.Doc, Can i get hiv by cleaning the organ by massage towel after the massage which lasted for 35 min.I am a family man and I don't have any other relations or sex earlier with other females. Should i go for one more test at 3 months mark i.e. from 3 days from now. Please suggest me what to do next.kIndly help me understaNd the results. I am under enormous stress since 3 months.

Excuse me for my poor english and sorry for my lenghty mail.

Awaiting your reply!!

Response from Dr. Frascino

Hello,

First of all, I agree with your doctor: Your HIV-acquisition risk is nonexistent.

Second, if indeed there was a potential HIV exposure, the recommended HIV-screening test for diagnosis is an HIV-antibody test at the three-month mark. HIV plasma RNA PCR viral load tests are not recommended for routine HIV screening due to the rate of false-positive results, other technical considerations and cost. Most likely your detectable viral load was the result of a "false positive" test. (You can see some of the "technical" problems I mentioned above being related to transporting the specimen to another city and not getting a result for 11 days!)

Third, I do not agree with ordering either a Western Blot or CD4 count without a proper indication for doing so! Western Blot tests should only be run to confirm a repeatedly reactive (positive) preliminary ELISA, EIA or rapid test. CD4 counts are not HIV diagnostic tests. Your results are predictably normal.

My advice is:

1. If you're worried about HIV, get a single HIV-antibody test (ELISA, EIA, rapid test) at the three-month mark. The results will undoubtedly be negative.

2. Find a more competent physician.

Good luck.

Dr. Bob



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