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Nave patient with questions

Apr 14, 2011

Dear Dr. Frascino, Thank you for your sound advice to the many questions asked in this forum I think I have strained my eyes from reading post after post and on that note I have three questions that require your expertise. 1- Is a PCR test a definitive diagnosing tool? I have researched on this and the consensus seems to be divided as it has in itself not been approved by the FDA as a diagnosing tool but rather as a gauge to monitor treatment response. I was diagnosed based on a PCR test that picked up 1500 copies and at a second re-test it picked up 150,000 copies all in a matter of 5 days. At my physician's recommendation I started treatment with Atripla and Isentress. 2- Is a reactant Elisa and an undetermined Western blot cause for celebration? After my diagnosis I was still in denial desperately waiting for my Woo Hoo moment but three months seemed like an eternity so after only a month of my possible contagion encounter I got tested at an AIDS organization with a quick response blood test which barely showed a second red line, the counselor had to ask another person to confirm the test was reactant and after using a flashlight and bending over the stick for minutes they agreed that it was reactant, the counselor drew blood to do a confirmatory western blot and a syphilis test to reject co-infection. The results were given to me a week later and although the counselor confirmed that I was HIV positive the results on the form seem contradicting, the Elisa was reactant however the interpretation given by the technician indicated "positive(negative)A" and even though the western blot detected five bands (G24,G41,G50,gb120,gb160) it also indicated (no bands). On the one month follow up with my physician he drew blood and told me to discontinue with Isentress after I ran out of refills. I asked for a copy of the results and again the Elisa was reactant however the western blot was undetermined and it suggested repeating in 4-6 weeks, it picked up the same bands as previously but according to this technician I needed to have 2 G bands to be positive. At this point I am confused as to what the results really mean and if mistakes could have been made in the analysis or the interpretation. (Did I mention I am hoping for my Woo Hoo moment?) 3- Should I discuss with my physician to continue taking Isentress along with Atripla? After the blood work revealed a decrease on viral load to 210 copies my physician recommended discontinuing with Isentress after only 2 months of starting my ART. I have read in POZ magazine that Isentress is a wonder drug that not only reduced viral load to undetectable levels on new patients but it also worked in patients that were receiving other treatments. I have not experienced any discomfort and I do not have a problem adhering to my schedule I have not missed a dose and I always take them at the same time every day. I hope I was as clear as possible on my details but if you require I can forward a pdf attachment of the test results. I wish my physician was as thorough and as willing to answer questions as you are but at least he is an infectious disease expert so I dont think Im that bad off. Wishing you the best and awaiting a response, you fan. Bob in NY

Response from Dr. Frascino

Hey Bob in NY,

1. The FDA has approved only one PCR RNA test for HIV diagnostic purposes so far, the APTIMA HIV-1 RNA qualitative assay. You can read about this test and other HIV diagnostic tests in the archives of this forum.

2. The criteria for a positive Western Blot (WB) are reactivity to gp120/160 and to either gp41 or p24. Consequently your results -- gp120/160, gp24, gp41, gp50 -- would be considered definitively positive, not indeterminate.

3. You should discuss all your concerns with your HIV specialist, including your treatment options. It's possible your HIV specialist is basing his recommendation on resistance tests, indicating you are sensitive to all three components in Atripla. If so, you may not need Isentress to drive your HIV plasma viral load to undetectable levels. You could then "save" Isentress for the future, in case you need an alternative regimen.

Good luck! Be well.

Dr. Bob

not taking my meds
What can we do.

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