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Newly Diagnosed Not been to ID Specialist have questions on testing
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Newly Diagnosed Not been to ID Specialist have questions on testing

Hi,

Thanks for taking time to read my post and help address my questions.  I am a gay male who has recently been "diagnosed" with HIV based on an early detection panel test. On 11/12/12 neg OraQuick test.  1/7/13 high fever of 103.  No other symptoms.  2 days later I broke out in a rash on the inside of my arms and my torso. Rash lasted 5 days and did not look anything like rashes for "HIV" that I could tell.  It did not itch and was not sore.  Sore muscles no other symptoms.  Fever lasted 5 days. 1/11/13 OralQuick = negative.  1/14/13 Online STD lab testing.  Took it to LabCorp  Results =1/22/13. I suspect contraction mid to late December.  I was visiting Adult bookstores where I was the receiver of oral sex and the giver.  I also had protected anal sex as the recipient. No condom breakage.  I have never had a man ejaculate semen in my mouth or in my anus. There is always, I suppose pre-*** to consider.  Multiple partners. I went to my family physician who looked over the tests, no info on results and am getting appt. with ID spec.  I need help interpreting the test results.  I was tested for Hep B, C, Syphilis, Chlamydia, Herpes, & gonorrhea.  Here is what was provided on the HIV:

HIV DNA RT by PCR:  Positive Abnormal  - HIV−1 DNA detected
HIV 1/O/2 Abs−Index Value 15.96 High
HIV 1/O/2 Abs, Qual - Repeatedly Reactive Abnormal  Non reactive
Western Blot - Indeterminate
What does the HIV 1/O/2 Abs−Index Value 15.96 High mean?  what does value mean? Is that viral load? I suppose there is no chance of a false positive with the PCR test?  Right?  If conclusive, when should I start therapy?  I have heard earlier is better.  
239123_tn?1267651214
Welcome to the forum. Thanks for your question.

No online forum can or should replace direct professional care.  You must follow through on the referral to an ID specialst, then follow that doc's advice.

Your test results are very typical for an early HIV infection.  The combination of HIV DNA in your blood, plus a high-value HIV antibody result (an ELISA ratio of 15.6 indeed is quite high), plus an indeterminate Western blot, all are highly typical for an HIV infection of 3-4 weeks duration.  I'm confident that if and when the WB is repeated, it will no longer be equivocal but clearly positive.  And the symptoms you experienced certainly were consistent with those of acute retroviral syndrome (ARS).

I don't see any value in peculating on the exact mechanism by which you were infected.  I would guess that the condom failed, without your knowledge, during the anonymous anal sex event; but I cannot rule out the possibility that you acquired the infection by performing fellatio on an infected man.  The odds of the latter are low, but rare things happen sometimes.

You'll have to wait for your visit with the ID specialist for advice about when to start therapy.  This isn't a settled issue:  the trend in the past few years has been toward earlier and earlier therapy, and some experts believe all patients should be treated immediately.  In any case, this isn't an issue to be decided on the basis of distant online advice, only with direct in-person care by an expert.

I'll be interested to hear how it all shakes out after your ID specialty appointment.  Please return with a comment to let us know.

Best of luck--  HHH, MD
12 Comments
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Avatar_m_tn
Thanks Doctor Hansfield.  Do you think the ELISA ratio was high because I was in the process of Seroconverting?  I had heard that the viral load is high during the seroconversion then it declines or does it keep going up?  Am I in danger if I can't start therapy for a couple of weeks?  I am trying to get an appointment with the ID but it seems to be taking a bit longer to get in.  I will certainly let you know what I find out once I get an appointment.  thx
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Avatar_m_tn
Sorry, One more comment.  Since the seroconversion, I have felt absolutely fine.  No fevers, rash, pain.  A little tired, but that could be due to stress/lack of sleep due to anxiety.  I have heard people who go through a long serocoversion process are at higher risk for developing AIDS sooner and a shorter life span.  Is this true?  Sorry for the follow-up questions.  thx
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239123_tn?1267651214
There is absolutely no need to apologize for this sort of follow-up question!

The viral load has nothing to do with the ELISA ratio of an antibody test. The numerical value says nothing about the amount of antibody in the blood or the significance of the test result.  If the cut-off is, say, 1.0, a value of 3, 5, 15 or 25 means nothing except "positive".

I'm glad you're feeling well at present, but I'm afraid it doesn't mean anything in relation to your viral load or long-term prognosis.

I'm angered at the ID doctor or his office staff (not at you!) when I hear they will not or cannot see you immediately, i.e. within a few days.  While not exactly an emergency of the same sort as a gunshot wound, it is very important that you be evaluated very promptly -- and every ID specialist worth his or her salt knows this.  If you cannot be seen this week, I recommend your call your PMD and insist that s/he intervene to assure a prompt appointment; or that you be referred to a different ID specialist.  
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239123_tn?1267651214
By the way: I hope it doesn't need to be said, but you should be refraining from any and all sexual activity for the next several weeks and maybe a few months. Probably you are more infectious for others now them you will ever be.  With the very high viral loads common in early HIV infections, even apparently safe exposures may carry substantial risk of transmission. At a minimum, wait until you are treatment and/or have a low or undetectable viral load.
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Avatar_m_tn
Definitely.  thanks
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Avatar_m_tn
Besides from abstaining.  I also travel (fly) a bit for my job.  Do you know if I should try to minimize so I am not exposed to germs as my CD4 count will be much lower?  I am hoping these questions will help others.

Thx!
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239123_tn?1267651214
HIV infected people are not especially susceptible to colds, influenza, or other airborne infections -- in fact, no elevated risk for any infection until late in the course of progressive immune deficiency, until overt AIDS develops after several years.
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Avatar_m_tn
Hi Dr. Hansfield.  Since I have not been to my ID specialist yet, (Feb 24).  I was told I should possibly do another antibody test.  Today I took another OraQuick test and the results were negative.  Do you think it is still too early that I am not developing antibodies?  It was suggested by a counselor on POZ.com that I should be showing some antibodies at this stage.  Please advise.  thx
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239123_tn?1267651214
Your previous results were definitive, and I would assume the most recent test is falsely negative, especially if it was an oral fluids test.  Recent research has shown that the oral fluids tests often take longer than the blood tests, including the rapid blood tests, to seroconvert.

I recommend you continue to assume you are infected, and address these issues with the ID doctor when you have that appointment.  (I still don't really understand the long delay, but I've already said my piece about it.)  In the meantime, you could consider another antibody test -- but this time, have another lab-based test, not a rapid test of any kind.  If you do so, you should expect a positive result.  If it does not, you'll need another Western blot and viral load (PCR) test -- but I suggest you leave that to the ID specialist.
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Avatar_m_tn
Hi Doctor Handsfield.  You asked for me to post once I had my visit.  I had an excellent visit.  One of the reasons that took so long is that I am actually seeing a world renowned HIV Specialist (lucky I live where I do).  It was a great visit and he fully expects I will live a long life.  Vitals looked great.  Just got some of my tests back.  I am still waiting on Genotyping and Resistance, but my CD4 is 481 and my viral load is still high at 300,000.  This is very concerning for me as I don't know why it is still so high.  Not sure what I can do at this point but start therapy.  The genotyping and resistance testing will take a couple of weeks.  If all goes well I am set to start a clinical trial.  any thoughts why the viral load is still so high?  does this still have to do with the timing and early detection of the infection?  thx!
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239123_tn?1267651214
Hello again.  Thanks for the follow-up.  I'm very glad to hear your in an excellent care setting.

I can't speculate on why any particular person has higher versus lower viral loads, or slow versus rapid CD4 decline, in the months after primary infection.  To my knowledge it isn't known and may be nothing more than luck.  If there is an answer, your highly expert HIV specialist undboubtedly knows better than I do; you should ask him.  In any case, I'm confident no harm will come with another two weeks before starting therapy, with the speciific regimen tailored to the genetic/resistance analysis.

That will wind up this thread.  Best wishes for successful therapy and a long and productive life.
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This Forum's Experts
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H. Hunter Handsfield, M.D.Blank
University of Washington
Seattle, WA
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Edward W Hook, MDBlank
University of Alabama at Birmingham
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