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Weakly reactive test followed by negative viral load test
Jun 29, 2011

Hi Doctor, I've got a big problem.

I was stupid one time, and had unprotected vaginal sex with a prostitute, who was, well, not in the classiest area of town shall we say. Yes, I know I'm an absolute idiot. :(

3.5 weeks after the exposure, there was some pain/irritation in my penis. I went to the clinic and got tested for everything- all came back negative except for the HIV-test, which they said required further testing. How it was explained to me was 'the test looks for 3 things in your blood, one of those came back positive, and 2 came back negative, so we have to run further tests'. They also ran a PCR test on the same sample, which came back negative (viral load undetectable).

I then went back after 6 weeks, and tested again. They did a HIV rapid test which I got the results for within 30 minutes, which came back negative. They wanted to send off a blood sample to the lab as well however. I've just got the results back. This time, it was explained to me that '2 out of the 3 things we look for in your blood came back weakly reactive, and one was negative, so more testing needs doing'. They also ran another viral load test on that sample, which again came back negative/undetectable.

The doctor I spoke to on the phone said to come back in 4 weeks, but said that he was 'almost certain' I didn't have HIV, but that he couldn't be 100% sure.

In your experience what's the odds with those types of results that an individual has HIV? I'm freaking out because me 3.5 week test showed 1 weakly reactive result, and now the 6 week test shows 2 weakly reactive results, so I'm thinking I was starting to seroconvert during the times the tests were taken. 2 out of 3 reactive (even if they're only weakly reactive) is surely pretty bad, right?

But then on the other hand, most information on the internet says that at 6 weeks the majority will test fully positive for HIV, and that at about 3-4 weeks a viral load (PCR) test will be able to detect HIV in the blood.

I just don't know what to do, there's so much conflicting information out there. In your experience, do these types of results normally turn out truly positive in the end, or negative?

Response from Dr. Frascino

Hi.

Reviewing your laboratory tests to date, they indicate you are HIV negative. HIV is not your problem. No way. No how. No additional HIV tests are warranted.

I'm not exactly sure what they are talking about with the "3 things" they are looking for. (Perhaps ELISA, p24 and Western Blot???) If your first test was somehow equivocal, your undetectable quantitative HIV plasma RNA PCR viral load would be strong evidence of your negative status. If they were concerned you were in the process of seroconverting, your subsequent rapid test at six weeks would have been definitively positive. (Yours was negative.) The blood test would also have been definitively positive by then. Their report of "2 out of the 3 things being weakly reactive and one was negative" doesn't make much sense. That your repeat PCR RNA viral load remained undetectable is additional proof you are not infected.

I see no reason to go back to this doctor/clinic. They seem totally confused about proper HIV testing recommendations and interpretation. Diagnosing HIV disease really isn't rocket science. And although clearly your doctor/clinic folks are not rocket scientists, they should be able to appropriately order and interpret HIV diagnostic tests! Consult a more competent HIV-knowledgable physician if you remain worried. I'm confident he'll agree HIV is not your problem!

Dr. Bob



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