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What does LOW RISK mean to you and what ELISA trying to tell me?....tail between legs

Aug 30, 2009

First of all I, I owe you an apology... I feel that I did not explain myself correctly and some of my comments/questions may have come off as ignorant and/or offensive to you personally and others who are HIV+.

For clarification, I donate blood because it is, as you say, laudable and I do what I can to help. My comment about the free blood test was in reference to getting results about my triglycerides, sodium, cholesterol, etc on a regular basis.

I was in, what I thought to be, a monogamous relationship for the last 5 years and had always had normal test results (for everything including negative HIV), therefore, I had never considered the thought of being in contact with HIV or in anyway at risk. If I had had any doubt whatsoever, I certainly wouldnt have even thought about donating until I was 100% sure. I am not that irresponsible!

The reactive ELISA blind-sided me and my boyfriend who is equally ignorant about what this result means. This is when all hell broke loose and he fessed up. I am making myself sick with the waiting (second test done 3 days ago). There is so much contradicting and confusing information out there that I dont know what to believe and what to latch onto.

I understand that my statement about HIV being all hype was taken out of context and maybe I was unnecessarily trying to be controversial. I would never in a million years make light of HIV or those who are infected. I am just really really really confused from the literature regarding my low-riskness and the statistics and what the ELISA result means. To a certain degree, we all believe what we want when we read this stuff. I personally went from being one of those it could never happen to me people to Oh my God, it happened to me.

The negative WB results makes me feel better but I am still taking into consideration the window period. It was short like 10 days from the last sexual encounter short. Whatever the result is on this second test (why doesnt the Dr just call!?!??!), I will follow it up with another one after 3 months.

Again, I certainly did not mean in anyway to offend you with my hype question. I empathize with you as a HIV+ survivor, (although, from the spirit of your responses and your tenacity to keep your organization so successful, you do not seem like a person who needs anyones sympathy.) I guess I was just looking for someone (i.e a medical professional in this area) to calm me down.

I did read the archives and I dont want to be one of those worry warts who is asking you to quantify my risk I guess I just wanted more info on the message, if any, ELISA was setting me up for. I could be missing another possibility but it seems like the most common reason for a reactive ELISA test is pregnancy. I am not pregnant.

Thank you againI need to exhale. If you arent completely fed up with me by now, I will send you my results. Hopefully we can WHO HOO together.

Response from Dr. Frascino


Welcome back to the forum. Thank you for your clarification and comments. I was pleased to read that you would not be so irresponsible as to risk the blood supply simply to get an HIV test. If you read the archives, you'll find others unfortunately are not so responsible. These egocentric individuals have put others at potential risk for their selfish needs. (See chapter on blood donations.)

Regarding blood-donation screening, as I've stated many times before, the testing is done to protect the blood supply, not to diagnose HIV disease. As such the testing errs on the side of "false positives" so as not to miss any true positives. A positive ELISA from the blood donation center does not mean you are HIV infected. It merely means you need more specific testing. The Western Blot is a more specific test and overrides the reactive ELISA. In other words a reactive ELISA plus negative WB is considered a negative HIV screening test. I see no reason for you to be concerned about your test results. The reason for concern would be the potential exposure from your boyfriend. I would recommend he get a rapid test. If negative, you can relax somewhat. He (or you) will still need a definitive HIV-antibody test at the three-month mark from the last potential exposure.

As for reasons for a reactive ELISA, there are many, not just pregnancy. Non-specific cross-reacting antibodies can be produced for a variety of reasons and confound the very sensitive ELISA test. That's why we have more specific follow-up confirmatory tests required for an HIV-positive diagnosis.

I remain confident you'll be WOO-HOOing soon.

I'll make one last comment: How is it that both you and your boyfriend could be so uninformed about HIV? "It could never happen to me" attitudes are exactly what continue to fan the flames of this volatile and dynamic pandemic. I'm hopeful that as a consequence of this experience both you and your boyfriend will get informed and perhaps even help inform others. We could stop HIV cold in its tracks if we all became informed and did our part. Your apology is, of course, accepted. I hope you'll now consider helping us turn the tide on this scourge. WOO-HOOing feels great. Helping others in need by doing your part to battle HIV/AIDS feels even better.

Good luck. Be well.

Dr. Bob

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!

Advertisement Response from Dr. Frascino


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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