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Your take on my Results Doc
Apr 27, 2009

Hey Doc..first off thank you so much for your time and this site..great! And I plan on donating to you this next pay! So here it goes. I had a unprotected encounter sometime near the end of january or very early february cant remember the exact day. I went for my routine exam with my family doc (shes great!) where I always get tested for HIV. This was March 3, 2009. She called me back in a week later telling me my ELISA had come back reactive, but my confirmatory western blot was negative. She immediately got on the phone with a HIV specialist here in town and I saw her two weeks later, around March 27, 09. During this 2 week break between the visits, my family doc ordered lab tests for my Tcell count and a HIV-Qualitive PCR test. The results for those two tests showed t-cell count of 1100 which is good, and the PCR test did show a result of 19k load. So..i arrived to the specialist as I said on March 27,09 with these tests as well. My specialist then ordered, well a lot of tests (hep-B, all STDS, t-cell,etc.) all which were normal/negative. She also ordered another western blot which was negative, almost 3 weeks after the original western blot was neg. I go back to the specialist in June. My question to you is what is your take on all these results? I know for a fact I have been neg since I am tested yearly and sometimes have been tested twice in a year all showing neg. After approximately 13-16 weeks after the risky encounter, why would my ELISA be pos, and two western blots neg, but showing a 19k load? As i am writing this, it has been almost 15- weeks since possible exposure and I have showed no signs of Acute HIV Syndrome. I know you say "syptoms" mean nothing but I am sure most infected people have some. Thanks so much for taking my question.

Response from Dr. Frascino

Hi,

I agree your test results to date are a bit confusing. However, I believe there is at least a chance you are HIV negative. (This is assuming you do not have any extenuating circumstances: for instance, your partner being from West Africa where HIV-2 is endemic, etc. I'm confident the HIV specialist already covered this ground with you.)

No doubt your decision to have unprotected sex does place you at some degree of risk for STDs, including HIV. However, a repeatedly reactive (positive) ELISA with a negative confirmatory Western Blot taken outside the window period (three months) would be considered a negative HIV screening. Your tests are not yet at the three-month mark, so they can not be considered definitive. I'm a bit confused by your report of an HIV-qualitative PCR. Was this really a "qualitative" HIV PCR DNA test or was it a plasma HIV "quantitative" PCR RNA viral load test with a value of 19,000??? Generally speaking HIV PCR assays are not recommended for routine HIV screening, due to their rate of false-positives (usually with low viral load titers). That you had two negative Western Blot tests three weeks apart would argue against a seroconversion reaction in process.

Consequently we are left with two possibilities:

1. You are HIV negative. In this case your screening ELISA and low-titer viral load would be false-positives.

2. You are HIV infected, but have not yet completely seroconverted. In this case I would have expected a higher viral load and also that your Western Blot would be showing at least some bands during the three-week interval.

Your follow-up tests in several weeks will sort out this conundrum. I'd lay my odds on scenario #1.

I probably don't have to point out the fact that a simple piece of thin latex used properly could have avoided this entire fiasco!

Good luck. Write back and let us know what the follow-up tests show.

Dr. Bob



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