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More Bad news Dr. Wohl. Please advise.
Oct 11, 2012

Dr.Wohl,

One last time Sir, i can come and meet you, if you can give an appointment.

This is regarding my 3 year old kid, who is now 4 years old. The western blots are negative upto 1 year after the blood contamination incident. THe EIA was non reactive at 6 weeks after the incident, but it changed to reactive, when she was tested at 5 months 20 days after the incident and remained reactive at 13 months after the incident. But the western blot is negative. The pediatrician has done a PCR for HIV1 Quant which is <20 copies after 1 year after the incident.

The EIA remained reactive, because i checked with the nurse, the doctor ordered HIV ab with Reflex the third time also, i thought he just ordered western blots.

You help so many patients and people in need. Can you save one family with your answer? I am living my life every day in disaster, am not even sure if i will live till the next day. Your answer one time will be so helpful. You have the expertise and i do not have access to a ID specialist. I do not want to disturb you. But you are everything to me at this critical junction of my life.

All i need to know is three things?

a) Do you think she is severely immunodeficient and if she is severely immunodeficient, is that the reason why EIA is coming reactive and the western blot is coming negative?

b) Do you think any of these inflammatory conditions like lupus or RA or anything else would result in a false negative PCR Quant?

c) Should i be worried about the EIA turning from non reactive to reactive? Do you suspect anything here. Do you suggest any more tests for other conditions or anything else? How can we find out what is causing the EIA to be reactive. and why is that they wont print a reactive EIA or elisa in the report, and they just print the western blot test result.

Please advice me with your expertise? You can understand what i might be going through, especially if it is regarding my loving kid.

They say everything happens for a reason, and because of this incident and because of this EIA converting from non reactive to reactive and staying reactive. Who will take care of my child if i die with this stress, i did not sleep for one day properly after all these results and i am taking so much toll mentally.

One last time respected Dr, I want to do what you advice if any other tests are recommended.

I am just coming from the pediatric orthopedics doctor, because this is the second time that is happening to my daughter in the right knee, it is leaking fluid inside, looks like swelling but it is all fluid inside.

So the doctor told that since it is the second time but again going back so fast, he thinks it must be inflammatory conditions, but is giving the benefit of doubt and will wait for one more time, and then if it happens again he said blood work needs to be done for some diseases like lupus, rheumatiod arthritis and some other names i don't even remember. THis happened two times in the past two months, but the fluid is going back in like three days and the knee looks normal.

I do not know from where and how these things are coming.

Can you get lupus or RA or any other inflammatory conditions with a blood contamination?

She was a healthy child before that, she was born with a good weight and height, and our pediatrician used to say she is above the 99 percentile and that she is going to take her in her basket ball team. i had a surprisingly bad news on Tuesday. Only a ID specialist can advice me as to what i need to do.

Also do any of these inflammatory conditions like lupus or RA or others cause a false negative PCR quantitative for hiv1?

Yesterday i had to take my daughter to the pediatrician. and i found out that The third time also the doctor ordered HIV1/2 AB with Reflex. I thought the third time straight western blots were ordered. So that means the EIA again came reactive.

A recap, EIA was non reactive at 6 weeks after the exposure, then was reactive at 5 months 20 days after the exposure, and finally reactive again after 1 year after the exposure, but western blots are negative.

Also on the HIV-2 Western Blot report under the negative status there is a statement stating under the negative result stating that

"Confirmatory Western blot testing is more specific than initial EIA screening, however discrepant EIA results should be followed up or repeated as clinically indicated"

It is not there under the HIV1 western blot test result and it was never there on any western blot reports when she was tested second time.

The third time(after one year after the incident), the doctor also ordered a HIV 1 PCR Quant result it says Normal, HIV 1 Viral Copy <20 copies/ml and HIV 1 Viral Log < 1.301 LOG COPY/ML.

I was reading about the reasons for a positive EIA and some places it is mentioned as a simple reasons like immunizations, flu, upper respiratory infection and most of the time like syphilis, lupus, lyme disease etc.

Her symptoms are continous cold and cough from the past one year, espcially after the needle blood contamination incident. After that incident she is continously falling sick every month with runny nose, cold, cough and sometimes fever. It has been close to one year now and we are dealing with the same situation day in and day out. Before the incident i rarely remember taking her to the doctor once every 6 month.

We are always dealing with cold and cough for the past one year now, regularly about 15 to 20 days a month after the incident. and i told you about that Vitiligo spot which came after 7 months after the incident. I do not know from where the vitiligo spot came.

{{About the incident, my 3 year old daughter had an unfortunate needle, blood contamination incident in a genetic clinic.

So basically the blood came into the hands from the torniquet and was transfering the blood everywhere including at the spot where the blood was drawn. }}} In short previous patients blood came in contact, and unfortunately it got injected at the spot where it was dr

Even regarding the contamination i wanted to add one last thing which is that the person drawing the blood got all the blood to his hands and he used a butterfly needle. I was kissing my daughter and not looking what happened, i also think that the blood might have entered from the butterfly needle at the position he holded, because blood was on his fingers. Anyway now everything is over.

The document had all blood stains the one he gave to me and that is the document i gave him for the appointment, which was given by my actual pediatrician and was referred to a genetist.

The guy was a very old guy and he was wearing spectacles, he asked me to tell my daughter saying that it will pain, so i was kissing my daughter who was lying on the bench, and not noticed what happened. The blood was dripping from the tourniquette.

So she got in contact with a previous patients blood at a genetic clinic.

In short previous patients blood came in contact, and unfortunately it got injected at the spot where it was dr

My pediatrician also was upset saying that he should not have done like that, and she told me that i should have stopped it. I know it is my mistake as well.}}}

After three days after the day of the blood contamination incident, she had high running nose, cough, and after seven days after the blood was drawn, she has high fever from the past four days including the running nose and cough, and is taking ibuprofen to control the temperature, and an antibiotic as well.

Do you suspect any severe immunodeficieny and do you think is that why the western blot is coming as a false negative?

If at all you suspect anything or if you think i should get anything else please do let me know.

We are always dealing with cold and cough for the past one year now, regularly about 15 to 20 days a month after the incident. and i told you about that Vitiligo spot which came after 7 months after the incident. I do not know from where the vitiligo spot came.

Before the contamination incident, she was a healthy baby, i rarely used to take her to the doctor.

I want to get this of my mind, but at the same time i am very much worried. What can i do to resolve this discrepancy about the EIA converting into reactive from non reactive.

Do you suspect anything else, or recommend any other tests. Do you think that my daughter is immunodeficient and that is why the western blot is coming as a false negative, after a reactive EIA. Finally why do they not report a reactive EIA in the test result?

Should i get the PCR qualitative tests instead of the quantitative for HIV1 and HIV2 as i read that PCR quantitative might come false negative. I am almost in my last stage with all these stress. Please help me one last time. I will never bother you again. Even if you do not want to answer, atleast please give me an appointment. I will personally come and meet you there. thank you.

Response from Dr. Wohl

It is a bit confusing but I think I understand the data. Again, I believe that the exposure was minimal and low risk. I do not know why your daughter is not well. Her HIV testing indicates a false positive EIA. She certainly does not have HIV-1. Her Western blot is negative and her viral load is undetectable.

As to HIV-2, this is rare in most places. Unless you are in an area where HIV-2 is relatively common, I have less worry about this. Again, her Western blot for HIV-2 is negative and that is convincing to me. It does not matter what is written on the lab report as different lab kits come with different standard language. To answer your specific questions:

a) Do you think she is severely immunodeficient and if she is severely immunodeficient, is that the reason why EIA is coming reactive and the western blot is coming negative?

No. This does not make sense. Why would her system react with some antibodies (like on EIA) but not Western blot? This is not an issue.

b) Do you think any of these inflammatory conditions like lupus or RA or anything else would result in a false negative PCR Quant?

Definitely not. The PCR looks for actual virus. There should be no disease that influences detection of the virus by this test.

c) Should i be worried about the EIA turning from non reactive to reactive? Do you suspect anything here. Do you suggest any more tests for other conditions or anything else? How can we find out what is causing the EIA to be reactive. and why is that they wont print a reactive EIA or elisa in the report, and they just print the western blot test result.

It certainly adds worry but this is the problem with testing when the situation is low risk. Your daughter makes an antibody that cross reacts with the EIA. This may be due to an over-active immune system - supported by your telling is she has vitiligo and now arthritis.

d) Can you get lupus or RA or any other inflammatory conditions with a blood contamination?

No. These are not infectious diseases.

So, your child may have a rheumatological disease and that could explain everything. As an infectious disease expert, I see no evidence of infection given the data you have shared.

DW



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