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What does LOW RISK mean to you and what ELISA trying to tell me?
Aug 26, 2009

Dear Dr. Bob,

I became a blood donor last year first of all because it is a good thing to do but also for the "selfish" reason of getting a free blood test every 6 months. My first test last year was completely normal and I was able to donate. The second test (6 months later) gave a reactive ELISA result with a reading of 1.39. They obviously went ahead with the Western blot and found everything to be negative. I WOULD be sighing with relief IF my long term boyfriend hadn't admitted that he had been sleeping with someone else for a few months shortly before I took the second test. There had been a few occasions of unprotected sex. To give you some timelines: he was out and about during the months of April to June. I was tested on July 20. My doctor assured me that she is 99% sure that I have nothing to worry about. I know NOTHING about the ELISA tests but as the cut off is .99, I don't like being 1.39. I am in a"low risk" community (not really sure that means but I think it is safe to say as I live in a well-to-do city where I have never heard of or met anyone who has been infected). I am anxious really because I have no idea about the history of this other person. In June, she told my boyfriend that she had had a blood test done and everything came back fine...but who knows if she is telling the truth. As the window period is still considered short, I wonder if the reactive ELISA test could be trying to tell me that something is going to turn up. Is that possible? Is the ELISA indicative of something on its way that isn't yet shown on the western blot? And, if it isn't HIV, what could the ELISA be reacting to?

I took a second test 2 days ago and am waiting for the results (with MUCH anxiety!) The doctor did say that it is possible that the ELISA could come back reactive again with WB negative. why? Basically I am writing to you to ask a) what your definition is of "low risk" and b) what is the ELISA test reacting to? why is my number higher than the cut off if I have "NOTHING to worry about."

I know you don't have a crystal ball or anything but reading through (A LOT) of your answers, it seems you almost ALWAYS say "don't worry, you are fine." This makes me wonder: are we ALL just overreacting? Is HIV all hype? I know it does seem to be connected to certain profiles but, in the end, I have always been taught that it is this horrible monster that doesn't discriminate and it could get you just as easily as anyone else. I am absolutely NOT trying to criticise you or the important work you and your colleagues do but I was born skeptic. It just seems like you play down quite a number of, what I would think to be, valid fears which derive dubious test results after "risky" experiences.

Anyway, I would feel reassured if you could give me some insight about what you think the ELISA test is trying to tell me if anything. Again, I wouldn't be so worried if I didn't have the RECENT infidelity situation to consider.

Thanks again for all you do. Again, with this recent scare I have been reading quite a lot on various sites and forums and I am disappointed to see that even in 2009 there is a serious lack of education out there about HIV and safe sex in general..... I guess I fall into that category too!

Response from Dr. Frascino

Hello,

I'll make several comments about your post.

1. Becoming a blood donor because it is a good thing to do is laudable. However, becoming a blood donor to get free HIV screening is unconscionable!!! If you have or had any inkling of doubt that you are HIV infected, donating blood could put many people at risk. The testing that is performed at blood donation centers is designed to protect the blood supply, not diagnose HIV disease!

2. A reactive ELISA and negative confirmatory Western Blot is considered a negative HIV test. You can read more about false-positive ELISA tests in the archives of this forum. Your combined test indicates you are HIV negative as of the test date.

3. Is HIV all hype? That's an odd question to be asking a person (me) who is HIV positive and struggling with the challenges of coexisting with a virus that wants to kill me. It's also demonstrates a shocking lack of knowledge about the global pandemic.

4. Yes, I play down "fears." I do not play down the virus.

5. You may be a born skeptic, but that shouldn't prevent you from becoming better informed about HIV/AIDS.

Dr. Bob



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