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Negative Elisa but Indeterminate WB - PLEASE HELP
Jun 27, 2001

Dear Doctor, thanks a lot for your good work and I hope I am at the right forum for this question.

7 days back , I had one instance of unprotected oral and vaginal sex with a Russian commercial sex worker . With in 86 hours of this sexual act, I located this lady and had various tests performed on her . Her results:

Contagious disease , Skin Problems , Syphilis , herpes, Urine test = None and overall healthy

Elisa ( For HIV 1 and 2 ) = Negative.

The details of Western Blot are as follows :

SGP 120 ( For HIV 1 and group O ) = Positive / Negative P 24 ( For HIV 1 and 2 ) = Positive / Negative P 31 and P 17 ( For HIV 1 and 2 ) = Negative GP 41 ( HIV 1 ) = Negative GP 36 and SGP 105 ( For HIV 2 ) = Negative

My doctor said the result was INDETERMINATE . There is no way that I can locate this lady now ( for re testing ) and my country does not have the facilities to do Nucleic acid test .or Viral load test or CD 4 or other advanced tests. And I plan to do my tests ( if I do not die before of the tension ) after 4 weeks.

My specific queries ( based on above test results ) are as follows:

1. Based on the above results, can I infer that the lady is in the early stages of acute HIV infection.

2. If low chances of HIV + , then what could be the reasons for SGP 120 and P24 to be +/-. ( For the last 5 months - the sex worker has not been on any medication , has had no major sickness or Malaria , has not worked with animals, had no blood transfusion , however she had a failed pregnancy 8 months prior to above tests) ?

3. Is this the time when her ( the sex worker ) Viral load and therefore her chances of infecting anyone would be the highest - I am assuming this as she has yet not started producing enough antibodies to show clear positive and she could be in early stages of seroconversion / acute HIV infection.

4. Most importantly - Is this the time when my chance of getting infected are the highest ( assuming the ladys high viral load and early stages of seroconversion / HIV infection ). This was my first and the ONLY unsafe sex encounter - The unprotected vaginal sex , in which we both ejaculated , was for 120 180 seconds and the details of the unprotected oral sex are: - she sucking me without condom ( 300 seconds ) and I putting my unwashed finger ( that was deep inside her vagina for 5 minutes ) in my throat ( to induce vomit so as to throw up the alcohol inside me, and I did vomit a lot immediately ) for 20 seconds . What are my chances of contracting HIV from this encounter and from this lady ( kindly take into account the above Elisa and WB test results) ?

5. Generally , during the course of unprotected oral and vaginal sex ( Like above ) , is the risk of being infected higher when the person has the above Elisa and WB test results ( I am assuming that the test results indicate high viral load / seroconversion / early stages of acute HIV infection ) as compared to having unprotected oral and vaginal sex with a person who has already tested HIV + on Elisa and WB tests ?

Response from Mr. Kull

Let me try to make this response as simple as possible: if you want to know you your HIV status, get tested at least three months after your exposure. Getting your partners tested and obssessing about the details will not give you the answer that you need.

I'm not completely sure why a Western blot test was conducted when you had a negative ELISA for HIV-1 and HIV-2. Western blot testing is regularly used as a confirmatory test, when one has a reactive/positive screening test. In the United States, plasma is screened for HIV antibodies with the ELISA test FIRST. If that is negative, no other testing is needed. If it is positive, then Western Blot testing is used. If the Western Blot is positive, then the sample is positive. Using two tests practically rules out the possibility of getting a false positive result.

Western blot testing can have reactive bands on 2-15% of non-infected persons tests. Many will be indeterminate. That's not a good argument for using Western blot testing alone.

None of this means that your partner is guaranteed to be HIV-negative. Having all of the testing in the world performed on her will not give you the information and security that you need to know your own status.

RMK



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