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Confused about test results
Apr 21, 2009

Hi, I am very confused maybe you can help me understand. My boyfriend had a severe attack of salmonella food poisoning on Jan 16th 2009. He was admitted to hospital and doctors found that he was HIV positive on Elisa testing. He was put on Atripla on the 24th Jan 2009. His CD 4 count was 24. We later did a viral load test vut viral load was undetectable. This is where the confusion started as the HIV specialist could not explain the low viral load and low CD 4 count. He therefore went and did a PCR test and CD 4 count test about three weeks after he had started the antiretoviral therapy. PCR test could not detect any virus but his CD 4 counts are still below normal at 187. He went back and did another Elisa and Western blot which both came back positive for HIV 1 and negative for HIV 2. We are really confused because the PCR came back negative and the Elisa and western blot positive. So is he HIV positive or negative? I had to get tested too as we were having unprotested sex for the past six months. I tested negative the first test and am due for my follow up test. Please help clear up on my boyfriends status.

Thanks

Response from Dr. Frascino

Hi,

I can see why you are confused! I'm a bit confused myself and I'm not certain I can definitively sort this out over the Internet without having access to all the information.

At the time of your boyfriend's initial positive ELISA while hospitalized with his bout of salmonella, did he have a confirmatory Western Blot as well? If not, he should have!

You report he was started on Atripla on January 24, 2009 and "we later did a viral load test but the viral load was undetectable." How much "later" was the viral load test run? It's possible the Atripla drove the HIV plasma viral load down quickly to undetectable levels. That could be one potential explanation. Certainly laboratory, technical or clerical error is another possibility.

Because your boyfriend has had a subsequent positive ELISA and Western Blot, I do believe he is HIV infected. He seems to be responding well to Atripla (CD4 count increased from 24 to 187). If for whatever reason your boyfriend's doctor is still uncertain about his status, a qualitative HIV DNA PCR could be considered. Personally, I don't believe it's necessary.

You will need HIV-antibody tests at both the three- and six-month marks to confirm your negative status because you have had a significant exposure to someone who is confirmed to be HIV positive.

If your boyfriend doesn't know about this site, please have him check us out! There is a wealth of information here for both of you. I'd suggest you both begin with "The Basics" chapter that can be easily accessed on The Body's homepage and proceed from there.

Good luck to you both.

Dr. Bob



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