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I'm ready to end it if I'm infected
Sep 23, 2009

Dear Dr. Bob, You've heard this a million times, but PLEASE HELP ME. I'm at my wits end. I can't go on if I get the bad news this week.

I'm a gay man and I've made some really stupid choices in my life when it comes to safe sex. I'm the top when it comes to it, but I don't always use a condom. And it usually ends up being more teasing anyway, and if it goes in, it's only for a minute.

Anyway, I've always gotten tested regularly. Everything's been fine since July 2009 and then in August I volunteered to donate blood at a drive. About two days before donating, I messed around with someone, a little insertion but that's it.

A week later, I got a letter stating that the ELISA was reactive but the confirmatory tests (using IFA and NAT) were negative. The counselor repeatedly told me to not worry, seeing this all the time, absolutely sure that I don't have it. I freaked out and have been panicking with extremely high anxiety since then. Last week (about five weeks after the first blood test) I got tested again with my doctor and got back the results today. They also indicated a reactive ELISA but they went with the Western blot as a confirmatory test. The p24 band showed up. So now they're going to do the DNA/RNA test (which I think is the same as the NAT test the blood center did?)

I am so confused by the tests now and can't function normally in my daily life. The counselor says there's no way I could be infected because the viral particles are not in my system, but they didn't use the Western blot, which they apparently used to use but have now transitioned to the IFA method.

I'm tired of being in this limbo land and need to know your candid opinion of my status and situation so I can make appropriate plans.

May God have mercy on me.

Thank you, Lost, Scared and Alone

Response from Dr. Frascino

Hello Lost, Scared and Alone,

Combining all your testing results to date, you are most likely (almost certainly) HIV negative. However, I need to add some qualifying comments and will make some general comments as well.

1) I generally tend to skip over questions in which the questioner threatens to commit hari-kari if he doesn't get an answer of if he tests positive, etc. I find it more than a bit insensitive to the 34,000,000 of us who struggle to live every day with this virus. Had I jumped off the Golden Gate Bridge in January 1991 when I became "positively charged," I wouldn't be here now to answer your question or to calm your drama-queen histrionics!

2) If you had even a limited amount of unsafe sex, why were you volunteering to donate blood? That is an unconscionable decision. Donating blood when there is even a slight chance you might be HIV infected puts the blood supply (and recipients of your blood) at risk. Had you truthfully answered the pre-donation questions, you would have (and should have) decided not to donate! Have you no respect for the health of others or how devastating this disease can be? Time to grow up and wise up! Perhaps this experience with your own positive ELISA tests will give you some insight into your cavalier actions such as having unsafe sex or particularly your decision to then donate blood! If I sound disappointed in your decisions, it's because I am.

3) Regarding your HIV tests to date, a repeatedly reactive (positive) ELISA followed by a negative IFA and NAT is considered a negative HIV-screening test, although those who have this testing pattern are not allowed to donate blood. It's important to note that the type of HIV screening done at blood donation centers is designed to protect the nation's blood supply; it is not designed to diagnose HIV disease. As such, the testing will pick up some false-positives, in essence erring on the side of protecting the blood supply, even if it has to forfeit some donations from HIV-negative (but falsely positive) donors, such as yourself. The counselor was correct. Your testing indicated you were HIV negative (but your blood still could not be accepted). No further testing was warranted based on those test results. An IFA (immunofluorescent assay) is equivalent to a Western Blot in sensitivity and specificity as a confirmatory test.

4) Your follow-up test revealed a reactive ELISA and indeterminate Western Blot with only a p24 antibody band present. Once again this most likely represents a false-positive ELISA. I strongly anticipate the qualitative HIV DNA PCR will be undetectable. (This is a slightly different testing assay than the pooled NAT used at blood donation sites.)

5) The only reason I am hedging somewhat rather than giving you a completely "all clear" assessment is that you had "a little insertion" unprotected two days before your attempt at donating blood. This potential exposure places you at some degree of risk for STDs, including HIV. You will need an HIV-antibody test at the three-month mark from the date of the last potential HIV exposure to have a definitive and conclusive HIV-negative status. Since your exposure was brief, it's extremely unlikely you acquired HIV from this "stupid choice," as you put it. However, since there is at least a slight theoretical risk, repeating HIV-antibody testing at the three-month mark is warranted. Certainly if your qualitative HIV PCR DNA test at five weeks is undetectable (negative), this would argue very strongly that you are not HIV infected.

You asked for my "candid opinion" and now you have it. Rather than asking God for mercy I would advise you wise up and become more responsible.

Good luck.

Dr. Bob



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