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Inconclusive antibody and low viral load

Jun 1, 2011

I am a msm, generally anally receptive. I've always had safe sex. I had my six month HIV test, got results two weeks later which came back inconclusive ELISA, PCR said RNA found and Western Blot was abnormal positive (2 bands). Went to ID doc appt two weeks later who says I was exposed within a month of the testing. He did viral load test, nothing else. CD4 = 953 and VL = 1600. "Helper cell" ratio = 1.68. I tested negative back in November. The inconclusive tests were in April. Is it correctthat my exposure was within a month of the inconclusive tests? And I had a very bad yeast infection (still raging) throughout all of this. While I'm not in denial, my immune numbers seem high and VL seems low. When should I test again to confirm my diagnosis? ID says no need for additional tests and will just do viral load in three months. Is VL confirm infection?

Response from Dr. Frascino


Without seeing the exact test results (which bands were positive on the WB, etc.), it's difficult for me to comment. If your ELISA was "inconclusive," your WB positive, and a qualitative RNA PCR also positive, the possibility of being HIV infected is quite high. However, even with very straightforward positive results, I repeat the diagnostic studies just to rule out any technical or clerical errors. I would suggest you get an HIV test (with reflex WB if the ELISA is positive) three months after your last potential exposure.

Your doctor is assuming you are in the midst of seroconversion. He may be correct. Personally I would confirm that suspicion and if found to be true, I would strongly recommend you consider beginning antiretroviral therapy immediately to preserve immune function and prevent damaging immune inflammation. If your ID doc is not an HIV specialist, consider getting a second opinion regarding diagnosis and treatment.

Good luck.

Dr. Bob

Defensive medicine practise or sound judgement on HIV

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