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confused and anxious
Nov 23, 2010

Hi Dr. Frascino,

This will be my final time writing you since I have taken full advantage of your knowledge and guidance during this whole process. You have been so helpful in answering my questions and offering what little peace I have had during this difficult time that I just need to hear from you about this last issue that's been weighing down on me.

I have been writing you regarding an indeterminate blot test I had, followed by 2 negative elisa tests, one that was 2 weeks later and the other 7 weeks later. My boyfriend also tested negative.

First, I just want to thank you because you gave me the courage to call up my doctor and ask why he ordered a western blot test on me in the first place. I was shocked to find out that I was right in my assumption that he NEVER ordered an Elisa or EIA first. He claims there was a "glitch" in the ordering system and the blot was ordered by accident...interesting. It's scary that there are these kinds of incompetent doctors out there.

you would think at this point I would have closure with this issue but the problem is that I am a nurse and come into contact with bodily fluids often and so this has all really messed with my head and has made me paranoid to the point where I am really having trouble at work. Although I have never had a needlestick injury, I keep wondering if I was not careful at some point and could have possibly been exposed.

I have searched through the archives to try and find reasons why a blot test would come back indeterminate for me but I have had little success in easing my worry. I have had no medical problems thus far in my life, I have no autoimmune disease to my knowledge, am not pregnant or had the flu/flu shot recently or had any of the other things which would cause an indeterminate blot result. I did have a cold at the time of my original testing but this wouldn't affect the results right? Is there anything you can offer me to help explain what might have caused this result. I know this is a difficult question it's just that I feel like I can't go on another day torturing myself with this. Is there anything that will put my mind at ease and give me closure once and for all?

Thank you so much again for your time and thoughts.

Response from Dr. Frascino

Hi,

There is nothing wrong with you; it's a problem with the sensitivity/specificity of the test! That is why we don't use Western Blot as a stand-alone diagnostic test for HIV. It works extremely well as a confirmatory test following a positive EIA/ELISA rapid test, but used alone its rate of indeterminate (and false-positive) test results is too high. Stop searching for a cause of an abnormal test result from a test that was inappropriately ordered! If you cannot put these irrational fears permanently to rest with my reassurance plus your negative ELISA tests and particularly if "this has really messed with (your) head and made (you) paranoid to the point (you) are having trouble at work," you should seek counseling (psychotherapy) to help you confront and conquer these totally unwarranted fears.

Good luck.

Dr. Bob



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