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Follow-up to the post "I'm ready to end it if I'm infected"
Oct 7, 2009

Dear Dr. Frascino,

Last Monday my doctor called me to inform me the DNA PCR test came back undetectable. From what I gather on other posts, is this a WOO-HOO moment for me?

I want to thank you so much for being the voice of reason and giving me some solace during my anxiety- and stress-ridden turmoil. I've learned so much from this experience. And I would like to know how I can support you and your cause. Please let me know where and how I can donate to further your important, compassionate work.

I also have a few more questions. Let's just set it up with the premise that I don't ever put myself at risk for contracting HIV. Now, is it possible that the p24 band could somehow be dormant now and activated in the future and I would develop HIV? Does having the p24 band mean I have HIV-like particles in my body? Would it be possible that a future test comes back negative (on ELISA and Western blot) or will I always test positive on ELISA and indeterminate on Western blot? What do I tell any significant others when it comes to HIV status? Even though the blood banks won't accept blood of this testing type, does that mean my blood is not safe for transfusion?

Thank you a million times over. By the way, your smile is so comforting. And beautiful.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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

Response from Dr. Frascino

Hello Ready to End It If I'm Infected,

Congratulations and yes, WOO-HOO! I'll try to briefly address your residual concerns (although the answers to these questions can already be found in the archives!).

1. A "p24 band" cannot be "dormant." The p24 band represents a circulating blood protein, an immunoglobulin (antibody) made by your immune system. In your case this protein is a cross-reacting protein. It actually is not a specific antibody directed uniquely against the p24 antigen of the HIV virus, because you are not HIV infected. The undetectable qualitative HIV PCR DNA proves there is no virus in your body. Hence, there is nothing for your immune system to make antibodies against. I realize this is a bit complicated, but stay with me. You have a circulating antibody directed against something else (we all have many different types of antibodies circulating in our blood), which is cross-reacting with the HIV test assay, giving you a false-positive ELISA and indeterminate Western Blot reading. Antibodies, such as p24, are not alive. They do not cause infectious diseases.

2. In your case the p24 band is a cross-reacting antibody that has absolutely nothing to do with HIV, because you do not have HIV.

3. It's possible that you will test HIV-antibody negative in the future. However, I've also seen a number of cases where the false-positive ELISA and indeterminate Western Blot pattern persists for years and years (again completely unrelated to HIV infection).

4. You can advise significant others that you are not HIV infected. No way. No how.

5. Your blood will not be accepted by blood donation centers, due to the safety standards set by the blood banks to protect the blood supply, even if it means they need to discard or refuse donations that are indeed "safe." (For instance, they don't accept blood donations from sexually active gay men, even when they persistently test HIV negative. I realize this doesn't make a whole lot of sense and I disagree with some of these policies.)

Finally, thanks for your thanks and the kind comments on my "comforting" smile. (Even though I was going for sexy rather than comforting. Drats!). Thanks also for your expressed desire to make a donation to The Robert James Frascino AIDS Foundation. Donation information for The Robert James Frascino AIDS Foundation can be found on the foundation's Web site at www.concertedeffort.org. On behalf of those who will be touched by your gift, please accept my heartfelt thanks.

Once again, I'm delighted you are no longer ready to "end it" and that you have definitively dodged the HIV bullet.

Be well. Stay well. (You are indeed well.)

Dr. Bob



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