Very faint line on OraQuick (twice!)

[Jack202]

I'm a 25 year old gay male in Asia, and I took OraQuick Advanced HIV-I/II test with blood on May 17. There was a very faint red line next to T and very clear red line next to C. The doctor said that this is positive, and he usually sees that when people are seroconverting. By the time 40 minutes had passed, the line got just a bit darker, but still very faint, almost grey. They drew my blood, and sent it to the city health department here. They did Western Blot, and it was indeterminate. So my blood was sent to the US equivalent of CDC. They did WB (indeterminate) and an antigen test (negative). I talked to the person who did the test, and she told me the bands on WB were very faint, but she does think I'm seroconverting. I was asked to provide blood sample again in 2 weeks. I got nervous, and did another OraQuick test without blood at a local clinic. (This was 10 days after the 1st OraQuick) There was a faint line, fainter than the 1st  OraQuick. This time, the doctor (different doctor than the fist one) said he would read that as negative, since it was extremely faint, and last time I had sex was over 4 weeks ago, I would have enough antibodies to make that line clear.
Last time I did something unsafe was about 6 months ago-- this guy inserted his penis without a condom for like 15 seconds, but no ejaculation. Last time I had sex was 4 weeks before the first OraQuick test. I did use a condom. I’d like to know..

-if negative people ever get those really really faint lines, ones you see if you look at it closely from like 5 inches away (and if this is common?) or nothing no matter how close
-I did have flu-like symptoms from April 7-18 (sore throat+fever, but no runny nose). Could it be possible that my body has antibodies for influenza which is cross reacting?
-if I caught HIV 4 weeks before WB, wouldn't I have gotten reaction on WB and also a rather clear line on OraQuick?

Thank you!

[Edward W Hook, MD]

This question is at the limits of my expertise.  In general on all such tests, a faint positive line is just as positive as a bright one- the intensity of the line is not important.  The indeterminate WB however casts some doubt on whether you are truly seroconverting or not.  My guess is that there are several approaches to sorting out this most difficult problem and yo may wish to pursue several of them:

1.  If you are seroconverting, there should be detectable HIV in your blood by PCR. While we do not routinely recommend this test as a diagnostic test for HIV, in this situation doing another, totally unrelated test such as a PCR should provide results relatively quickly and help.  If the PCR is positive, there is no question that you have HIV.  Conversely, if you have a negative PCR, it makes it very unlikely that this is HIV and the problem becomes to try to sort out the basis for your result.
2.  Multiple repeats of your serological tests at this time will be of little help but, in a few (at least two weeks) a repeat blood test, including a Western blot would be helpful.

I know this is a difficult situation for you.  It sounds like you have found some good doctors who are helping you to work this out.  Please let us know how things progress.  EWH

[Jack202]

Thank you for the answers. Have you ever personally seen a line so faint that you had to use a flash light to see it? I mean, I couldn't really see it at first, until I got very close to it. My 2nd doctor told me that it could be that I'm just seeing like a gutter where they have put reactive materials.... or.. is it that negative people get absolutely no line-- no matter how close with a flashlight..?

Also, what's the window period for Western Blot?
Thank you!

[Edward W Hook, MD]

A visible line is a visible line and yes, sadly I have seen faint ones.

The western bloot follows about the same time line as other blood tests.  EWH

[Jack202]

Thank you. I'm counting the days till my next visit..
One last question though-- if WB was indeterminate because I'm seroconverting, shouldn't the antigen test have been positive??
Thanks.

[Edward W Hook, MD]

Probably but, if I were you, I would like more information. The sensitivity of the antigen test is far lower than PCR.  EWH

[Jack202]

Hello,

So I got my blood drawn today (6/2), and ELISA came back positive. They told me it was 14.76 and the cut off is 1. I don't really know the unit, but that seems to exclude the possibility of being false positive. :(   I'm still waiting for PCR and Western Blot result.

For what it's worth, this is my history:

Before 3/30 - don't remember
3/30: anal sex w/A (used a condom but with lotion)
4/6: anal sex w/B (used a condom)
4/7-18: fever+sore throat
4/27 oral sex w/B
5/1 sauna (used a condom. pretty sure. but was drunk)
5/17 HIV test - OraQuick positive (faint line w/blood), antigen negative, WB indeterminate
5/27 oraquick #2 - OraQuick Positive (faint line w/ oral serum)
6/2 ELISA positive (14.76, cut-off is 1)

So I'm guessing fever from 4/7 to 4/18 was ARS, and I probably contracted HIV on 3/30, unless I had sex shortly before 3/30 which I don't remember.... WB was probably indetermiante because it was a recent infection, and antigen was probably negative because it has been 4+ weeks since exposure. I honestly don't know what happened considering I consider myself as practicing safe sex.

[Edward W Hook, MD]

Not much to add here.  Here int he US, it is not possible to get an ELISA reesult back on the same day except in the most unusual of circumstances.  Furthermore, the development of a positive Western Blot tends to occur very quickly following the beginning of antibody production, thus the scenario you descibe is most unusual.   As I said before, the best test for getting this sorted out is a PCR test at this time. EWH

[Jack202]

Thank you for your answer. Yes, I'm still waiting for the PCR and WB results from yesterday. I was able to get the result for ELISA  the same day because they had the lab on site.

I have my last question for you-- assuming that I'm positive (which seems more likely than not), and that this was an early infection (judging from the indeterminate WB from 5/17), do you usually recommend taking meds immediately in this sort of a situation? I've read some articles talking about how taking meds for a short period of time (a few months) in the early stage of the infection may slow down the HIV progress in the long run.

Of course, I will obtain a local HIV specialist's advice on this matter, but I wanted to know what the consensus was among the doctors in the U.S.

[Edward W Hook, MD]

There is no concensus regarding early treatment of HIV here in the US.  It is the subject of ongoing research.  No further discussion of this topic however- HIV treatment is beyond the scope of this site (See MedHelp note above).  EWH