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Multiple Western Blot "indeterminate" results.
Jul 7, 2009

Several weeks ago I had blood samples drawn and suprisinly enough to me, my doctor said the ELA screening was positive, but the Western Blot was negative. He recommended that we run more tests, and on a sample taken a week later I got an "indeterminate" result. He recommended I go to a specialist because his practice doesnt deal with this on an advanced level. I saw an infec. disease specialist and she expressed doubt that it was positive, and was suspicious of some testosterone boosters possibly changing my blood proteins somehow. She ordered more tests, but is unavailible until nxt week so she said I could have the results sent to my regular doctor if I wanted them sooner (which of course I did). So this time (this blood was drawn 16 days after the first sample) the Western Blot came back indeterminate again, but it was his opinion that this was more serious than the last time because he said the CD4 count was low according to their machine...and again recommended that I go to her and get confirmation. The white cell count and hemaglobin were normal.

I have an appointment with the specialist for next Tuesday (nobody else had openings sooner) but am trying to make some sense of this in my head. I did read online that other causes of low CD4 counts can possibly be flu and extreme stress. Well needless to say that since the first test has come back, and even more so since the 2nd one, my stress level has been to new heights. When I went to see the specialist (two days before they drew for the most recent tests) my blood pressue was 168/108, and had probably been like that for several days at that point.

Are there any other factors that can cause a low CD4 count? And does a low CD4 count, with normal white blood cell count, ALWAYS indicate HIV infection?

Response from Dr. Frascino

Hi,

The big question here is whether you've had any HIV-exposure risks! If you've had essentially no HIV risk, I would certainly agree with the infectious disease specialist that you are most likely not HIV infected despite your indeterminate Western Blot. There are a number of potential causes for indeterminate Western Blot tests. You can read about these in the archives.

It's important to note that your initial test, which showed a positive ELISA and negative Western Blot, taken together this is considered to be a "negative HIV screening test!" No additional tests were really warranted. However, now that they were ordered and you have two indeterminate Western Blots, additional evaluation will be necessary to clear this up. I don't understand why a CD4 count was ordered. It also was not warranted, as your HIV status is still very much in question. I would suggest a qualitative DNA PCR test to detect cell-associated proviral DNA. Although not approved or recommended for routine HIV diagnostic screening, this test can be helpful in sorting out indeterminate HIV-antibody test results, because this assay does not rely on anti-HIV antibody production.

Regarding CD4 counts, yes, they tend to bounce up and down for a wide variety of reasons. You didn't mention how "low" your count was. Consequently it's difficult for me to comment on what this actually means.

Your visit to the infectious disease specialist should definitively and efficiently sort out this conundrum. Try not to freak about, because at this point your status is still very much undetermined!

Good luck.

Dr. Bob



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