Bizarre test results...help!

Question

Hi Dr,

Thanks for the advice and info you provide here -it helps many of us cope with some very real and scary issues.

12 weeks ago, I had a relatively low-risk msm encounter (I was anal receptive) with as-far-as-I-know-and-he-says protected sex with no ejaculation. No sex several months before or after that. I came down with some nasty flu-like symptoms two weeks later and a 4 week viral load was UD, as was a 6 and 9 week Oraquick (negative). However, yesterday at the 12-week mark, I received a "faint" positive reactive result via Oraquick. My ID doc did a repeat Oraquick today and it came back negative. I'm terrified and confused as I'm waiting for the WB and another viral load to come back.

How likely is it that I could be seroconverting this late and is it possible that the test yesterday was just more "sensitive" than today's and picked up the antibodies being produced this late now? I've had no vaccinations or meds lately, not a drug user...pretty healthy except these recent nasty symptoms (hot flashes, nausea, etc.). What do the conflicting results mean and what's your take on them? I'm anxious and worried and whole gamut of other emotions. I'd appreciate your input...thanks again doc.

Answer

Hi,

Your test results are really not all that "bizarre," but your choice for timing and type of HIV screening tests is!

First off, your HIV risk is negligible if your MSM encounter was protected, i.e. latex condom was used properly and did not break. That seems to be the case: "as-far-as-I-know-and-he-says protected sex with no ejaculation." With that type of minimal potential risk, the only test needed would be a single HIV-antibody test at the three-month mark. PCR (viral load) testing is not recommended for routine HIV screening, due to the rate of false-positives, other technical considerations and cost. So if we disregard your multiple antibody tests prior to three months and your viral load tests, we are left with a 12-week OraQuick tests that revealed "faint positive reactive result," which was repeated today and found to be negative. In light of your "non exposure" and three-month test results, we can quickly conclude your initial 12-week "faint" positive OraQuick was a false-positive result. This will undoubtedly be confirmed by your Western Blot, which I'm confident will also be negative. The follow-up viral load test, I would not have ordered. You can read about many similar situations of both folks' testing inappropriately as well as false-positive test results in the archives. Have a look. You should find these testimonials and the other information you find there reassuring, OK?

Stay safe and you'll stay well.

Dr. Bob