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Confirmed Western Blot during Pregnancy, but no Elisa Completed
Feb 18, 2009

I have recently been working as a care coordinator/social worker for a client that had a confirmed Western Blot (GP160 Ab, GP120Ab, GP41 Ab, P24 Ab) for HIV late in her third trimester of pregnancy. Upon review of the labs, it appears that an Elisa was never completed. This client was retested (she had since delivered her child) and she was found to be HIV negative.

I have heard of Elisa being reactive and Western Blots being indeterminate, but is it possible to have a reactive Western Blot that is incorrect with all of the necessary bands present? I understand that if an Elisa had been completed and it was negative that the Western Blot would have never been completed, but what if it had been positive... and she was never retested?? To increase my knowledge regarding this issue, what is the standard of care for retesting (if any) when a person tests HIV positive when pregnant?

Response from Dr. Frascino

Hi,

I'm glad you'll be working as a "care coordinator," because from what you've relayed it certainly seems like the care there is in desperate need of coordination!

You are correct: Western Blot (WB) tests should never be run without first having a repeatedly reactive (positive) preliminary ELISA test! Western Blot tests are only used to confirm preliminarily positive ELISA, EIA and rapid tests. The reason they are not run independently is that they have a high rate of false-positive results. So whoever ordered that isolated WB obviously did so in error.

Next, if indeed your client was felt to be HIV positive (based on the positive WB), she should have had follow up with an HIV specialist physician and HIV-knowledgeable obstetrician. She also should have received antiretroviral drugs and possibly had an elective c-section to decrease the risk of mother-to-child transmission during delivery. So it seems there were several lapses of care in this case! Hopefully you'll be able to coordinate much better care for the next client.

Good luck.

Dr. Bob



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