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Positive Elisa, Indeterminate Western Blot, Negative Rapid Test HIV test was indeterminate?(INDETERMINATE HIV TESTS, 2009) (PREGNANCY, 2009)
Aug 13, 2009

Hi, Doctor -

Around 2 weeks ago during my annual OBGYN appointment, I received a HIV test. The Elisa came back repeatedly positive and the Western Blot was indeterminate with traces of P24. Freaking out, I then went to my local health clinic 4 days ago and took a rapid test. This test came back negative.

I am a woman in my late 20's. I have a male partner who I had unprotected sex with approximately 1 month ago. After my results, he went immediately to get a test and came back negative (Elisa, I assume - he went to an infectious disease specialist). We have been together for 7 months and he claims that he has only slept with me during this period (I know people say there is always a possibility he is lying). But, if he is telling the truth, what are the chances that I am HIV positive? I have never been pregnant and don't suffer from any autoimmune disease that I am aware.

I have gone to my follow up appointment where they performed the Western Blot again and a DNA PCR test. I will find out these results in around 1 week's time.

Response from Dr. Frascino

Hi,

You are most likely HIV negative. See below.

Dr. Bob

HIV test was indeterminate?(INDETERMINATE HIV TESTS, 2009) (PREGNANCY, 2009) Feb 21, 2009

Hi, I have been sexually active for over two years now. I got tested two years ago and it came back indeterminate so I got a more accurate test which came back negative. I am now pregnant with a different man so at the first OBGYN appointment I got all the tests including the HIV test. Once again it came back indeterminate. This is still happening after two years. If I was HIV positive, wouldn't it come back positive.. especially after two years? What does this mean?! Am I HIV positive or not..? I'm going insane trying to figure this out.

Response from Dr. Frascino

Hello,

There are a number of reasons preliminary HIV tests may be indeterminate. (See below.) An indeterminate preliminary test followed by a negative "more accurate test" indicates you are HIV negative. Pregnancy is one of the potential reasons for indeterminate HIV-antibody tests due to the presence of nonspecific cross-reacting antibodies. I'm very confident that "more accurate" tests will once again confirm your negative HIV status.

Don't go insane; you're fine, OK?

Dr. Bob

HIV...Scared (PREGNANCY AND FALSE POSITIVE HIV TESTS) Jan 18, 2009

Dr. Bob,

My wife is preganant with our first child. She has had multiple preganancies before, even a few miscarriages. Her two initial HIV tests came out positive ELISA, indeterminate Western Blot. Her last test came out positive Western Blot. I have been tested three times in the past 7 weeks using the OraQuick Advance (Oral and Blood) that gives you results in 20 minutes and all have come out negative. The last chance of infection for me would have been years ago. After discussing this with the doctors, they are confident I am negative. What would could have caused the positive Western Blot in my wife. We spoke to a infectious disease doctor and they were surprised by the latest results and ordered more testing. I am pretty confident that there is some type of error in the last test, but am going out of my mind. Can you help?

Response from Dr. Frascino

Hello,

Pregnancy can induce cross-reacting nonspecific antibodies that can lead to indeterminate or false-positive HIV-antibody test results. (See below.) If you are HIV negative and your wife has not had any HIV-exposure risk, there is really no way she could be HIV infected. I'm confident when the results of the more extended lab work return they will unequivocally show your wife is HIV negative.

Be well.

Dr. Bob

Thank you from Malaysia (PREGNANCY AND FALSE POSITIVE HIV TESTS 2008) Sep 20, 2008

I really thankful to your answers. Although I have not posted any questions but your forum had been my only support for the past 2 weeks since I got my wife's test report that show a Elisa reactive. I was so worried and wondered why the result would be so when both my wife and I were negative before the pregnancy and we are sure we are of low risk group. I've just got the Western Blot result today, it turned out to be negative. Before the WB report was out, your forum was the only source that given me great informations and helped me through the torturing 2 weeks. I will definitely donate to your foundation as it is really helpful and May God bless you.

RW

Response from Dr. Frascino

Hello RW,

I'm delighted you found the information here enlightening and reassuring. Being told you or a loved one had a positive ELISA test can be terrifying, particularly if you don't understand the limitations of that screening test and the very real possibility that the ELISA test may be falsely positive. HIV screening requires a two-part test. First, the ELISA (or EIA or rapid test) is done. If positive, a confirmatory test, such as the Western Blot, must be done and come back positive before a person can be told he or she has tested HIV positive! A positive screening ELISA test and negative confirmatory Western Blot test is considered to be a negative HIV test! (Such was the case with your wife.) One of the common causes of nonspecific cross-reacting antibodies that can cause a false-positive ELISA is pregnancy. In the archives of this forum, you'll find many such examples. I'll now add your wife's testimonial to this impressive list. I'll reprint a sample of these archival posts below.

Thank you for your donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's urgently needed and warmly appreciated.

Be well. Stay well. Cyber hugs to you and your family.

Dr. Bob

my worst night mare (PREGNANCY AND POSITIVE HIV TEST) Aug 30, 2008

hi doc,im a new mother of a two months old girl,before i had my baby i had three hiv tests and they were negative,im in bording school i las had sex with my fiance in my third month of pregnacy. he tested negative too every time he acomanies me to my gyna,but now after tho months since having the baby, my hiv test is positive, how can it be? i have not exposed my self or had sexfor the past nine months, my only partner is negative still, how is that, please assist doctor,

Response from Dr. Frascino

Hello,

The most likely explanation is that your recent positive HIV test is a "false positive" resulting from nonspecific cross-reacting antibodies that developed during your pregnancy. (See below.) If a repeat HIV screening test continues to be positive, consider either getting a qualitative PCR DNA test (these tests do not rely on anti-HIV antibodies) or seeing an HIV specialist to help sort out your true HIV status. Certainly, with previous negative HIV tests and essentially no interval potential exposures, there is every reason to believe you are HIV negative and your test was falsely positive.

Good luck.

Dr. Bob

Hiv found in routine pregnancy blood test Aug 26, 2008

Hi Dr. Frascino, I had a routine blood test for my pregnancy and the results came back with a trace of HIV Ag/Ab, the sample was sent for confirmation by Western Blot which those results came back as HIV 1 Western Blot indeterminate Gp 3 and HIV p24 Antigen Non reactive. My doctor said that I may have contracted the virus within the last 3-6 months which would cause an indeterminate Western blot result and I now have to wait another 6-12 weeks to have a another blood test. Im trying not to worry and I have read other posts on this forum which other people have had similar stories to mine but they seem to have had another illness or disease before the HIV test such as one lady had tetanus 8 months before her HIV test, I have been wreaking my brain trying to think of anything that I have had wrong in the last 3-6 months or where I could have contracted HIV and nothing comes to mind except my husband and I have both had tattoos but they opened a new packet for the needle and used individual ink pots which are disposed of after each person. Why would the HIV show up in my blood if I dont have it and what other antibodies could be mistaken for it? is it going to harm my baby? should my husband go and get tested? should we be taking precautions incase I have it and he doesnt? Please try and put my mind at rest as 6-12 weeks is such a long time to wait for a further answer.

Response from Dr. Frascino

Hello,

A "trace of HIV Ag/Ab"???? I have no idea what that even means. If we assume your screening HIV test was repeatedly reactive (positive) and we know your follow-up Western Blot is indeterminate (however, I don't know what "gp3" stands for) and your HIV p24 antigen is nonreactive, the sum of your HIV tests would be read an "indeterminate" HIV screening test. Indeterminate HIV tests can result from a variety of conditions, including pregnancy, due to the development of nonspecific cross-reacting antibodies. I would suggest you repeat your HIV screening test (rapid test, EIA, ELISA). If negative, you're HIV negative. If positive, repeat your Western Blot. If your test is again indeterminate, I'd suggest getting a qualitative HIV PCR DNA. This type of test does not rely on anti-HIV antibodies and can be helpful in sorting out indeterminate antibody-test results. I'll reprint below some posts from the archives that address this same issue.

Good luck.

Dr. Bob

3 inconclusive test results...? (PREGNANCY) (INDETERMINATE WESTERN BLOT) Jun 1, 2008

I am 37 weeks pregnant with my 4th pregnancy. Since Novemeber, I have had one ELISA test which read an inconclusive result, and two Western Blot Tests that both came back inconclusive as well. Why could this be? I have been told over and over by my ob/gyn that more than 1 inconclusive result of a Western Blot Teast should be taken as anegative result. I refuse to let that ride. I feel like I deserve a definite answer seeing as I have been in a monogomous relationship for 2 years with a man who last tested negative in March of this year. Before this pregnancy, my hiv test results always came back negative with no problem. Should I seek a hematologist's opinion?

Response from Dr. Frascino

Hello,

Should you see a hematologist's opinion? Why would you want to go to a blood specialist to find out about an abnormal HIV test? No, you should not consult a hematologist. Instead, I suggest you merely read the archives of this forum! The answers and reassurance you are looking for can be found there. See below.

Dr. Bob

Elisa Results +ve and reactive (FALSE POSITIVE ELISA AND PREGNANCY) Apr 26, 2008

Dear Rob,

I am 37 year old happily married man and have been married for more than eight years. We have two sons, eight and six.

My wife is 20 weeks pregnant. She went for all sorts of tests as per norm, but to our schock the Elisa results came back: POSITIVE/REACTIVE. According to the gynae, my wife is defintely positive.

The gynae and his friends are now forcing my wife to consider taking drugs to prevent transmission of the virus from mother to child. But, I am not certain what is going on...

I have read through some of the responses in your forum. It appears that the Elisa test results for pregnant women are quite problematic.

My question then is: Are the Elisa tests preliminary or final?

I need to continue living my life as normal as possible rather than worrying about the results all the time.

Response from Dr. Frascino

Hello,

Positive/reactive ELISA results must always, always, always be confirmed with a more specific test (Western Blot or immunofluorescent assay) before the person is labeled HIV positive. That your wife's gynecologist may not realize this is shocking and very worrisome. I would strongly advise your wife not take antiretroviral drugs until her HIV serostatus is definitively determined and confirmed. Have her consult with an HIV specialist if necessary. You should also ask the HIV specialist to educate the gynecologist so that others aren't subjected to similar misinformation and mismanagement. You might want to switch gynecologists. The one you have is woefully out of touch with basic HIV-screening information and guidelines.

I'll reprint some information from the archives below that pertains to false-positive ELISA tests as a consequence of pregnancy.

Good luck.

Dr. Bob

HIV test results (PREGNANCY) (INDETERMINATE WESTERN BLOT) Apr 22, 2008

I tested positive in 2005 for anti hiv 1 and 2. The supplemental HIV 1 and 2 were negative as were the western blot and the p24 antigen was non reactive. I only found out about this test after I became pregnant a year later in 2006 and both the HIV 1 and 2 were reactive again as well as the supplemental HIV 1 and 2, the western blot was negative and the p24 antigen was nonreactive. I was told I was negative. I have worried every since. I had a follow up a few weeks ago to ease my mind (2008 19 months post pregnancy) and my HIV 1 and 2 are still positive, the Supplemental HIV 1 and 2 are negative (nonreactive) the western blot is now nonspecifit reactivity and the p24 antigen remains non reactive...I am told I am most likely negative and to ease my mind I can have a follow up in 3-6 weeks. My baby is healthy, I feel tired all the time but relativly healthy. I am 43, and I do have night sweats but am not sure if it is perimenopause...of course all my symptoms make me think of HIV...I did have a needle stick injurty but was told the patient was negative...I have been married to a negative for HIV man for 3 years. My last partner (relationship ended in 2004) was negative...although I did suspect he cheated....please tell me what your opinion is...I worry all the time and it is making me stressed and depressed. I did breast feed my baby for over a year and would be devastated if I passed HIV onto him because no one seems to know how to determine indeterminate results...Help

Response from Dr. Frascino

Hello,

I agree the odds are astronomically in your favor that you are HIV negative. A positive initial anti-HIV-1/HIV-2 test followed by negative supplemental tests, including Western Blot and p24 antigen is a negative HIV test. Your recent nonspecific reactivity (indeterminate) Western Blot following a reactive (positive) HIV 1 and HIV 2 antibody screening test most likely is due to nonspecific cross-reacting antibodies possibly induced by your previous pregnancies. If follow-up tests are negative, you'll have confirmation you are indeed HIV negative and no further evaluation would be warranted. If follow-up tests are once again indeterminate, you should then get a qualitative HIV DNA PCR. This type of test is not recommended for routine HIV screening; however, it can be helpful in sorting out unclear or indeterminate HIV-antibody test results, as it does not rely on anti-HIV antibodies, but rather checks for a piece of the HIV virus itself. I'll repost some information about indeterminate HIV testing and pregnancy below. If in the very unlikely case you test positive for both the supplemental HIV tests and confirmatory Western Blot, you should then be evaluated by an HIV specialist.

Good luck.

Dr. Bob

indeterminate wb (INDETERMINATE WESTERN BLOT, PREGNANCY) Apr 18, 2008

im currently pregnant with my second child. the only thing my ob. told me was that my wb.was indeterminate what does this mean? do i have hiv? i noticed you talk alot about indeterminate results in pregnant women can occur, is my pregnancy causing this or what? my doc ordered a 2nd test and they havent come back yet whats going on??please reply i cant sleep at all!!!!

Response from Dr. Frascino

Hello,

Pregnancy can cause false-positive ELISA tests and indeterminate Western Blot results due to cross-reacting antibodies. I'd addressed this problem multiple times recently. See below. (Once again I encourage readers to "check the archives!" The answers you seek are frequently there waiting for your double click!)

Dr. Bob

Pregnancy with indeterminate western blot test (PREGNANCY WITH INDETERMINATE WESTERN BLOT) Apr 17, 2008

Thank you so much for your information and support. I just found out today that my second test came back negative. I hope this means that I am ok. I feel amazingly better. Thank you again for all that you do for people.

Response from Dr. Frascino

Hi,

Yep, that means you are absolutely, definitively and conclusively OK!

WOO-de-fricking-HOO!!!

I'll post your original question below, because this issue comes up not infrequently. Hopefully it will keep other moms-to-be from freaking out if they get an indeterminate test result.

Be well. If you haven't chosen a name for your new rug-rat yet, how about "Dr. Bob???"

Dr. Bob

Pregnancy with indeterminate hiv results (resubmitted from the fatigue and anemia forum) Apr 15, 2008

I am 12 weeks pregnant and my hiv test came back positive but inconclusive. I asked my doctor if I was givin the western blot test and they said no that is why they sent me some where else. I went to that place yesterday and they werent even going to test me again I had to tell them to do the western blot. Well I was looking through my papers they had on me and it said my number was 11 and that the western blot was equivalent for p24 but was indeterminate. So apparently they did a western blot. Does it sound like they did a ELIZA test? I have been going insane with worry. Can you explain what is going on to me or let me know if there is anything that I need to do to insure that this is right. I have had so many doctors and nurses tell me differently from others that I am so confused. Most of what I have learned has been research on the internet. Also can it come back that way because I am pregnant? My husband tested negative. That does not seem possible to me if I were positive.

Response from Dr. Frascino

Hello,

Unfortunately there is no way for me to know exactly what tests were run based on the limited information provided. What I can tell you is that HIV-screening tests are far too often inappropriately ordered (wrong test) and incorrectly interpreted. Can your pregnancy affect your HIV test results? Yes, and most likely that's exactly what's going on. (See below.) Please note that an "indeterminate HIV test is not a positive test. You can review additional information about indeterminate tests in the archives. Because your physicians seem to be quite confused, I would suggest you see an HIV specialist (or physician well versed in HIV medicine). He or she will be able to quickly sort out your HIV status conclusively by ordering more specific tests, if necessary. If, for instance, you have had a reactive (positive) ELISA and indeterminate Western Blot, the specialist may consider getting a qualitative HIV DNA PCR, as this type of test does not rely on anti-HIV antibodies and therefore would not be affected by non-specific cross-reacting antibodies (possibly produced as a consequence of your pregnancy or other condition). HIV DNA PCR tests are not recommended for routine HIV screening, but they can be very helpful in sorting out unclear or indeterminate antibody test results. I'm here if you need me.

Good luck.

Dr. Bob

Confused! (INDETERMINATE WESTERN BLOT, PREGNANCY) Dec 16, 2007

I am currently pregnant and at my first visit they tested my for HIV. I had an afair before my pregnancy so this is where the fear is from! The resutls were positive Elsa and indeterminant WB showing p24 band. This was about 9 weeks post exposure. At 14 weeks post exposure I had another positive Elsa, indeterminant WB with p24 band, and negative PCR. My husband also tested negaive at this time. The last test was done at about 20 weeks post exposure and it again came back positive elsa and indeterminant WB with the p24 showing. What is going on? Do I have HIV and/or what tests need to be done?

Response from Dr. Frascino

Hello,

Do you have HIV? No. Pregnancy in and of itself can cause cross-reacting nonspecific antibodies, which can cause ELISA tests to be positive and Western Blot tests to be indeterminate. That your "PCR" was negative is evidence that you are HIV negative and your antibody tests, "falsely" reactive. Your experience is not uncommon. See below.

Dr. Bob

indeterminate hiv results (INDETERMINATE WESTERN BLOT, PREGNANCY) Nov 23, 2007

Dr. Bob, At the end of August I became pregnant. I was on vacation and became extremely nauseated so I went to the ER. I was there all night because the ER doctor thought I might have an etopic pregnancy. He ran an ultrasound and found no evidence of this, so the next day I flew home. During this time I was quite sure I had miscarried. This was confirmed by my gyn. Upon going to get a physical examination, and since I was going to try to become pregnant again we ran all the normal tests which included the hiv test. I was shocked when my doctor called to tell me that my results came back indeterminate. The elisa was done and the WB came back indeterminate with a weak p24. Needless to I was extremely stressed. So I went back to the lab to another test run 2 months later. This test came back today. It was indeterminate with weak bands of p24 and p40. I am not sure if it matters but I noticed on the lab work that the alisa was not done this time. I have been married for 15 years, and have not been with anyone else. My husband is in the military and tested negative in Feb. I do not feel that there is any way that I could have become infected with hiv. I would really appreciate your take on this. Should I test again? Should I keep worrying. Please give your advice on this. Thankyou.

Response from Dr. Frascino

Hello,

Your situation reactive ELISA, indeterminate Western Blot during or after pregnancy is not uncommon. See below. The most common cause is cross-reacting antibodies resulting form the pregnancy.

If your follow-up test contained only a repeat Western Blot without a repeat preliminary reactive ELISA, the test was improperly ordered. Western Blot (WB) tests should always be coupled with EIA (enzyme immunoassay) screening, because alone WB tests have a 2% rate of false-positives.

I would recommend you obtain a qualitative HIV DNA PCR to sort out your indeterminate serologic test. Based on your history (no HIV risk), you should be HIV negative.

Good luck.

Dr. Bob

blot test (INDETERMINANTE WESTERN BLOT) Sep 26, 2007

I AM A 22 YR. OLD FEMALE THAT HAS BEEN MARRIED FOR 6 YRS. AND HAS 4 KIDS NOW. WHEN I WAS PREGNANT WITH MY LAST CHILD THEY DID A HIV BLOOD TEST AND IT CAME BACK POSITIVE FOR HIV. AFTER THAT THEY DID ANOTHER BLOOD TEST AND A WESTERN BLOT TEST. THE BLOOD TEST STILL CAME BACK POSITIVE BUT THE WESTERN BLOT CAME BACK INDETERMINATE. THE INDIVIDUAL TEST THAT IT HAS ALL OF THEM SAID ABSENT EXCEPT FOR P24 AND IT SAID ABNORMAL OR SOMETHING LIKE THAT. AND THE DR. TOLD ME THAT IT JUST LOOKED LIKE A FALSE POSITIVE AND NOT TO WORRY ABOUT IT. AND NOW AFTER 3 MONTHS I GO TO HAVE MY BABY AND THE BLOOD TEST IS STILL SAYING POSITIVE. COULD IT REALLY STILL BE A FALSE POSITIVE OR DO I REALLY HAVE SOMETHING TO WORRY ABOUT? AND WHAT ABOUT MY BABY? DOES THIS MEAN THAT HE HAS IT TO?

Response from Dr. Frascino

Hello,

I agree your tests are most likely false-positive ELISA tests due to cross-reacting nonspecific antibodies resulting form your pregnancy. A DNA PCR may be helpful in sorting out disputed or indeterminate serological test results. See below.

Dr. Bob

undeterminable/indeterminate May 11, 2007

I am pregnant and recently found out my HIV test came back as ELISA positive, Western Blot was "undeterminable" and the IFA was indeterminate. I have had the same partner (now husband) for over 3 years and I was tests a year ago. My doctor has never seen an undeterminable result before, and an IFA that was indeterminate. I am freaking out here, although I really feel that I am not HIV positive, I need some answers. Any ideas?

Response from Dr. Frascino

Hello,

Reactive ELISAs plus indeterminate Western Blots or IFA tests can occur for a variety of reasons, including the presence of cross-reacting nonspecific antibodies resulting from pregnancy. The most important factor in evaluating an indeterminate result is risk assessment. Your risk is essentially nil. Consequently I would agree you are most likely not HIV positive! A DNA PCR should help clarify your indeterminate serologic test results. Your situation is not unique. See below.

Good luck.

Dr. Bob

Am I ok or what?!? (INDETERMINATE WESTERN BLOT) Feb 21, 2007

Hi. I have always had negative hiv tests my whole life, including during a pregnancy in 1998 and another pregnancy in 2000. In 2003 I gave blood and it was rejected; a doctor visit showed inconclusive hiv/negative western blot. 4 months later a repeat showed the same results. In spring 2006, hiv test result was positive, western blot indeterminate. Doctor did a blood test called RPR which was nonreactive and HIV-1 RNA-PCR and HIV 2 test. All came back okay. Also saw an infectious disease specialist at that time. Both doctors agreed I do not have HIV in their opinions but cannot tell me why I went from negative to HIV inconclusive/western blot negative to HIV positive/western blot inconclusive over the course of my life. They say "you don't have hiv, don't worry" but can't explain it so I do worry about it. It seems like the blood tests are showing a progression over the years of some kind to me. I have constant swollen glands in my neck and lumps there also which another specialist determined through a scan were "not masses and nothing to worry about" but I also know that that is a sign of HIV. Because of my "weird" test results over the years I worry although I know swollen glands and lumps in the neck can also be results of sinus/allergies of which I do have other symptoms of (and I also have TMJ). I am tired of worrying and do not want to think of my HIV test results every time I get a cough or pain in my neck, etc.! I feel I am becoming a hypochondriac and I am stressed often about it. Do you have any advise as to my results over the years? Thanks so much.

Response from Dr. Frascino

Hello,

So the question is "Am I OK or what?!?" The answer is "OK," definitely OK. Your test results are not showing progression. Indeterminate tests are not positive tests by definition. The reason your multiple physicians have not given you a specific answer regarding your false-positive antibody test and indeterminate Western Blot is that there are many potential reasons, none of which is really important once we establish you are definitively and conclusively HIV negative. And that has been done. (See below)Whatever is causing your symptoms, one thing that's for sure: it's not HIV, OK?

Be well. Stay well. (Yes, you are indeed well!)

Dr. Bob

inderminate WB test (INDETERMINATE WESTERN BLOT) Feb 9, 2007

I tested positive in teh ELISA test and have an inderminate result in the WB test. In my opinion, I am a low risk person. In the past 3 years, I have had unprotected sex with 2 different guys, one being in the military, who has tested negative and one who was married for 10+ years before me. I am unsure what bands showed up on my WB test. What is the percentage of an inderminate WB test turning into a positive HIV test? I was told I could not get tested again for 3 months and I have asked my 2 recent sex partners to get tested.

Response from Dr. Frascino

Hello,

Indeterminate Western Blot tests account for 4% to 20% of Western Blot assays in various studies. The causes of indeterminate results include:

1. Serologic tests in the process of seroconversion; anti-p24 is usually the first antibody band to appear.

2. Late-stage HIV infection, usually with loss of core antibody.

3. Cross-reacting nonspecific antibodies, as seen with collagen-vascular disease, autoimmune diseases, lymphoma, liver disease, injection drug use, multiple sclerosis, parity or recent immunization.

4. Infection with O strain or HIV-2.

5. HIV vaccine recipients.

6. Technical or clerical error.

The most important factor in evaluating indeterminate Western Blot test results is risk assessment. Patients in low-risk categories with indeterminate tests are almost never infected with either HIV-1 or HIV-2; repeat testing often continues to show indeterminate results and the cause of this pattern is often not elucidated. For this reason, it's important to realize that HIV infection in situations like yours is extremely unlikely, although a follow-up test in three months is recommended to provide absolute assurance. Patients with indeterminate tests who are in the process of seroconversion usually have positive Western Blots within one month. DNA PCR may also be helpful for sorting out indeterminate serologic test results. An HIV specialist can help assess your HIV risk and interpret HIV test results if necessary.

Good luck.

Dr. Bob

indeterminate test result follow up (INDETERMINATE WESTERN BLOT) Feb 19, 2007

Dr. Bob,

I knew it!!! You were right..I called the lab and they told me that the walkin clinic had ordered the wrong test and did not run the screening HIV test. She told me sweetie you have nothing to worry about your HIV negative after looking at that and the viral load and P24. These clincs should not be doing this if they cant order the right dam test. Thanks for answering my post.

Response from Dr. Frascino

Hello,

You're welcome! I'm delighted another anxiety-provoking mystery has been solved. (Move over Sherlock Holmes, here comes Dr. Bob!)

Stay well.

Dr. Bob

indeterminate test results (INDETERMINATE WESTERN BLOT) Feb 17, 2007

I am a 24 yrs old heterosexual male. About 5 weeks ago I experienced a burring sensation in my urine after having non protective sex with a woman who now I am dating. I went to a walk in clinic and they prescribed me bacterium. After 1 week of that not working and a pain in my left side of my groin the clinic decided to do a whole STD test. Even a culture test for gonorrhea oh what fun!!(this was 14 days after the non protective sex)...6 days later I get my results back and I get a indeterminate test results(western blot) HIV on abnormal p24 and p40 nothing else. The doctor asks me my sexual history in the past 6 months and I tell them that the only person I was with was heterosexual sex with a college student that I am dating that had a STD check back in august and was negative for everything.(she says has only been with me since then) That day after telling me I don't have a lot to worry about he tells me we can do a antigen p24 test and viral load test just to make me feel a bit better. Both of these test with a standard blood test came back normal or negative. He reassured me again not to worry and to get another test in 4-6 weeks. I am an extremely high strung person and have been feeling a bit on the low side, along with a bit of sore throat and my tongue has been slightly sore. No fever or rash that I have seen on the Internet that goes along with a new infection. I don't know if these are factors of being extremely stressed about all this or a early HIV infection. What is your thoughts on the results of the negative p24 and viral load test based on my case. Also if I am negative what can throw the western blot of like this?

Response from Dr. Frascino

Hello,

You mention your indeterminate Western Blot result, but fail to mention if you had a positive ELISA test first! Western Blot tests should only be run to confirm a positive HIV-antibody screening test (ELISA or equivalent test). See below. This question unfortunately comes up far too often and reveals the fact that some clinics or physicians don't understand basic HIV testing and screening procedures!

Dr. Bob

I think I figured out the mystery Dec 12, 2006

Dear Dr. Bob... I appreciate so much, the information I have obtained from your forum...due to all of your generous responses to us worriers... I believe I may have solved the mystery of my indeterminate HIV tests. I wrote you a few days ago but have not heard back and I would love to hear your take on this situation for I am still a bit nervous. I am the female who has had two indeterminate western blot tests, the first being a weakly reactive p24 and the 2nd...two months later...being a weakly reactive p24 and p40. The day after I got my blood drawn for the 2nd test I was so anxious about waiting for the results that I went and got a unigold rapid test at a clinic, and the result was negative. So... I was baffled to hear I was indeterminate once again on the 2nd western blot and that this time, it seemed to have progressed a bit. I also had an ultra sensitive RNA test done a week after my 1st indeterminate western blot and that was negative. Yesterday, I went to see and infectious disease Dr. who is taking over my case from my OBGYN. She seemed to think I was negative but not really sure, and she drew blood for an HIV1/2 Elisa/Western blot. Well, today, I suddenly realized that my results from the two western blot results said nothing about an Elisa. Assuming the Elisa had been ran, I wanted to make sure and I called my OBGYN who had ordered the tests. She said she was pretty sure she only ordered a western blot...the lab then confirmed that I had not had elisas done.

I'm thinking...WHATTTT?? How can this happen...doesn't every Dr., especailly an OBGYN know that you have to run an elisa first? I've been distressed for 2 months!!! I'm hoping this means that I'm probably fine and that the rapid test result is more reliant?

I have to wait three weeks to get my Elisa result from the infectious disease Dr... and I'm hoping, in the meantime, you can shed some light on my situation. Do you think these reactions are HIV 1 or 2 and if not, should I be concerned about these reactions? All other STDs have been ruled out and the only person I could have gotten HIV from has tested negative on the orasure advance rapid 5 months out from his last partner and I haven't been sexual with him in almost three months. From reading your forum I learned that you must always run an Elisa first because Western Blots can yield a high amount of false positives if done without first getting a reaction from an Elisa?

Is this right? Does this mean I'm probably fine and I can breath again?

Thanks so much Dr. Bob for all you do... I will definitely make a donation when I am back to work and that's from the goodness of my heart and my true appreciation for you and your necessary services. And that is of course regardless of whether I receive a response from you. I read that someone actually accused you of only responding to those who say they're going to donate and that is a ridiculous accusation...it is appearant that you provide this service from the goodness of your heart to help those who need answers and suffering from anxiety.

Thanks Dr. Bob

Response from Dr. Frascino

Hi,

Congratulations on solving your own medical mystery using clues found in the archives!

The standard HIV-screening blood test consists of an EIA (enzyme immunoassay), like an ELISA, followed by a confirmatory Western Blot (WB). EIA screening requires a "repeatedly reactive" test, which is the criterion for Western Blot testing. Western Blot tests detect antibodies to HIV-1 proteins, including core proteins (p17, p24, p55), polymerase proteins (p31, p51, p66) and envelope glyco-proteins (gp41, gp120, gp160). Western Blot testing should always be coupled with EIA screening, because alone it has a 2% rate of false-positives. A positive WB is defined as reactivity at gp120/160 plus either gp41 or p24. An indeterminate Western Blot is defined as the presence of any band pattern that does not meet the criteria for a positive result.

Bottom line: you are HIV negative.

Be well. Stay well. Happy Holidays.

Dr. Bob

Indeterminate result Apr 25, 2004

Dear Dr. Bob, I recently had a HIV 1 test, and it came back as indeterminate. The results read "Viral bands observed, weakly reactive p31, HIV-1 Western Blot - indeterminate." I have been with the same person for the last 3 years, and we have both tested negative in the past. We do not engage in risky behavior (we don't do drugs, and we are monogamous). I don't feel sick and don't have any symptoms. However, I am very scared because of the result. What is the possibility that caused this result, and does the result mean that I may be HIV positive? What are my chances? Do I have any reason to worry? Thanks.

Response from Dr. Frascino

Hello,

Why did you have a Western Blot test done? Western Blots have a 2% false-positive rate. They must always be coupled with an ELISA test. "Indeterminate" Western Blot (WB) results can occur in 4% to 20% of assays. There are a variety of reasons why this occurs. Indeterminate results mean the test pattern does not meet the criteria for a positive result.

You have no identifiable risk factors for HIV. I do not believe you are HIV positive or in the process of seroconverting. (The anti-p24 is usually the first band to appear.) I do not believe you have any cause for worry. I would suggest you have an ELISA test. If negative, you can be reassured of your negative status. You should only repeat the WB if your ELISA is positive, which is highly unlikely.

Stay well.

Dr. Bob

inderminate WB test (INDETERMINATE WESTERN BLOT) Feb 9, 2007

I tested positive in teh ELISA test and have an inderminate result in the WB test. In my opinion, I am a low risk person. In the past 3 years, I have had unprotected sex with 2 different guys, one being in the military, who has tested negative and one who was married for 10+ years before me. I am unsure what bands showed up on my WB test. What is the percentage of an inderminate WB test turning into a positive HIV test? I was told I could not get tested again for 3 months and I have asked my 2 recent sex partners to get tested.

Response from Dr. Frascino

Hello,

Indeterminate Western Blot tests account for 4% to 20% of Western Blot assays in various studies. The causes of indeterminate results include:

1. Serologic tests in the process of seroconversion; anti-p24 is usually the first antibody band to appear.

2. Late-stage HIV infection, usually with loss of core antibody.

3. Cross-reacting nonspecific antibodies, as seen with collagen-vascular disease, autoimmune diseases, lymphoma, liver disease, injection drug use, multiple sclerosis, parity or recent immunization.

4. Infection with O strain or HIV-2.

5. HIV vaccine recipients.

6. Technical or clerical error.

The most important factor in evaluating indeterminate Western Blot test results is risk assessment. Patients in low-risk categories with indeterminate tests are almost never infected with either HIV-1 or HIV-2; repeat testing often continues to show indeterminate results and the cause of this pattern is often not elucidated. For this reason, it's important to realize that HIV infection in situations like yours is extremely unlikely, although a follow-up test in three months is recommended to provide absolute assurance. Patients with indeterminate tests who are in the process of seroconversion usually have positive Western Blots within one month. DNA PCR may also be helpful for sorting out indeterminate serologic test results. An HIV specialist can help assess your HIV risk and interpret HIV test results if necessary.

Good luck.

Dr. Bob

pregnancy and inconclusive HIV WB test (PREGNANCY) (INDETERMINATE WESTERN BLOT, 2008) Oct 16, 2008

Hi - I've read through this forum: http://www.thebody.com/Forums/AIDS/safesex/Current/Q196044.html and didn't quite seem to find my answer.

I am currently 14 weeks pregnant with my second child (Ive had miscarriages before and after my first child). I had blood work done at 10 weeks (mid Sept) and several weeks later, my OB called to tell me that I have a false positive for HIV - the ELISA was positive but the follow up WB was indeterminate. My OB told me not to worry and would do a follow up test in a couple of months. I am a low-risk group and have not been to W. Africa and my husband of 4 years did an HIV test after we heard this result and he was negative. I got a second opinion with a different doctor 2 weeks after my first test and did both a qualitative and quantitative (viral load) HIV test. The qualitative test was again similarly inconclusive (suggested repeat but confirmatory test is equivocal) with band p24 reactive and p55, p40 weakly reactive. The quantitative result was <75 (75 is detectable) and the HIV 1 log 10 copies < 1.9 and this doctor does not think I am HIV positive. I had returned from Nuevo Vallarta Mexico 4 days before my blood work with a nasty stomach virus and was still a bit under the weather (mild flu?) when I had my second test done. It would really put my mind at ease to know for sure and being a biologist by training, Im interested to understand more about how the biology behind the cross linking! Thanks in advance.

Response from Dr. Frascino

Hello,

A reactive ELISA ("positive") plus an indeterminate Western Blot are considered an "indeterminate" HIV screening test. This is not uncommon in women who are or who have been pregnant. (See below.)

I think you are confused about your second opinion tests. A "qualitative" test refers to HIV DNA PCR qualitative analysis. This has nothing to do with p24, p55 or p40 bands. The bands refer to HIV-specific antibodies. The HIV DNA PCR test is not an antibody test. Rather, it assays for Proviral DNA (genetic piece of the virus). I can only assume the results you reported were related to another Western Blot assay. The quantitative test is an HIV plasma viral load PCR RNA.

To sum up, you have several indeterminate HIV-antibody tests and an undetectable HIV PCR RNA. Your HIV-risk is exceedingly low. Taken in total, I agree you are HIV negative. You can read much more about HIV diagnostic tests (ELISA, WB, etc.) and HIV monitoring tests (PCR) in the archives.

Dr. Bob



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