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Confusing HIV Results
Dear Dr. Hook/Handsfield -
I am a male, no health problems, on no medications, and have never had any STIs. I had two exposures with the same male - the first time was kissing, mutual masturbation, and I received unprotected oral sex for a few seconds. I was chaffing a bit on my privates like one does on their hands in the winter with dry skin. On the second exposure it was just kissing and mutual masturbation. He had not been with anyone in the interim. He tested negative at least 66 days since his last encounter before me with an OraQuick Advance test - negative for HIV 1/2 and negative for all other STIs and he's never had any STIs. I myself have never had any STIs and tested negative at 68/41 days respectively from both encounters with a rapid and EIA - negative for HIV 1/2 (and all other STIs with a full panel). I tested negative again at 98/71 days with a rapid. At day 76 since the most recent exposure I requested an HIV RNA test and the results came back with low levels of positive. The doctor ran it by his friend (who looked at my results and did not test me) who specializes in infectious diseases and said it was a false positive and that if it were positive the numbers would be through the roof and not as low as they are. I did not know HIV RNA tests were not supposed to be used for routine testing. Do you think I am negative and this was simply a false positive? How do you recommend proceeding? I'm planning to go back for a rapid at 90 days (9 days from now).
I am a male, no health problems, on no medications, and have never had any STIs. I had two exposures with the same male - the first time was kissing, mutual masturbation, and I received unprotected oral sex for a few seconds. I was chaffing a bit on my privates like one does on their hands in the winter with dry skin. On the second exposure it was just kissing and mutual masturbation. He had not been with anyone in the interim. He tested negative at least 66 days since his last encounter before me with an OraQuick Advance test - negative for HIV 1/2 and negative for all other STIs and he's never had any STIs. I myself have never had any STIs and tested negative at 68/41 days respectively from both encounters with a rapid and EIA - negative for HIV 1/2 (and all other STIs with a full panel). I tested negative again at 98/71 days with a rapid. At day 76 since the most recent exposure I requested an HIV RNA test and the results came back with low levels of positive. The doctor ran it by his friend (who looked at my results and did not test me) who specializes in infectious diseases and said it was a false positive and that if it were positive the numbers would be through the roof and not as low as they are. I did not know HIV RNA tests were not supposed to be used for routine testing. Do you think I am negative and this was simply a false positive? How do you recommend proceeding? I'm planning to go back for a rapid at 90 days (9 days from now).
MEDICAL PROFESSIONAL
As i said before, I suspect your RNA test was falsely positive. that remains my opinion and now, the opinion of the infectious diseases doctor who (presumably) examined you. I would not worry further and think the recommendation for a follow-up test at six months had more to do with conservatism and providing you with peace of mind than any realistic chance the you have HIV. EWH
Hi Dr. Hook -
I'm just writing to give you a follow up on my case. I did see the infectious disease doctor and they said that the blip was most likely due to the flu shot I had received but that I should just get an EIA at 6 months to make sure everything is okay. Do you have a concluding thought on this? Do you think I'm negative? Have you ever seen anyone test positive beyond 90 days?
42 days - rapid/EIA - both negative
72 days - rapid - negative
76 days HIV-1 RNA bDNA (12 days prior had a flu shot) - low levels of positive
86 days rapid/EIA - both negative
93 days rapid - negative
I'm just writing to give you a follow up on my case. I did see the infectious disease doctor and they said that the blip was most likely due to the flu shot I had received but that I should just get an EIA at 6 months to make sure everything is okay. Do you have a concluding thought on this? Do you think I'm negative? Have you ever seen anyone test positive beyond 90 days?
42 days - rapid/EIA - both negative
72 days - rapid - negative
76 days HIV-1 RNA bDNA (12 days prior had a flu shot) - low levels of positive
86 days rapid/EIA - both negative
93 days rapid - negative
MEDICAL PROFESSIONAL
Yes, I have already indicated that you almost certainly have afalse positive test. EWH
I have definitely made arrangements to meet with an infections disease doctor, however I would just like to go in with as much information as possible from a specialist in the field like yourself. You said that "Typically the false positive results show very low levels of virus (<100)" - is this the case here? The following are my results:
This was the Versant (R) HIV-1 RNA 3.0 Assay (bDNA) kit:
Copies/mL (Version 3.0) H 415 <75 copies/mL
Log Copies/mL (Version 3.0) H 2.62 <1.88 log cps/mL
Dr. Handsfield wrote in one post (http://www.medhelp.org/posts/HIV---Prevention/RNA-Testing/show/1144625) that "And the RNA tests do have a slight chance of false positive results. In other words, if the result were positive, it wouldn't be reliable -- and think what you would experience for the next several days while waiting for confirmatory tests to show you didn't have HIV after all." Dr. Handsfield goes on to say that "Pooled testing works efficiently -- i.e. saves money and allows earlier HIV detection in sufficient numbers of persons to make it practical -- only when the prevalence of positive persons in the population is at a certain minimal level." I am writing from New York City so perhaps this changes things?
Dr. Handsfield has also said that "I agree that RNA testing should never be used as a standalone test" (http://www.medhelp.org/posts/HIV---Prevention/RNA-and-oraquick-swab-test-/show/1891685).
Your take on this would be much appreciated. Do you think this is a false positive and I am negative? Again at 6 weeks I had a rapid and EIA test (negative), a rapid at 10 weeks (negative), and a rapid and EIA test at 86 days (negative). Is it possible that I do not have enough antibodies yet or is this just simply not the case?
This was the Versant (R) HIV-1 RNA 3.0 Assay (bDNA) kit:
Copies/mL (Version 3.0) H 415 <75 copies/mL
Log Copies/mL (Version 3.0) H 2.62 <1.88 log cps/mL
Dr. Handsfield wrote in one post (http://www.medhelp.org/posts/HIV---Prevention/RNA-Testing/show/1144625) that "And the RNA tests do have a slight chance of false positive results. In other words, if the result were positive, it wouldn't be reliable -- and think what you would experience for the next several days while waiting for confirmatory tests to show you didn't have HIV after all." Dr. Handsfield goes on to say that "Pooled testing works efficiently -- i.e. saves money and allows earlier HIV detection in sufficient numbers of persons to make it practical -- only when the prevalence of positive persons in the population is at a certain minimal level." I am writing from New York City so perhaps this changes things?
Dr. Handsfield has also said that "I agree that RNA testing should never be used as a standalone test" (http://www.medhelp.org/posts/HIV---Prevention/RNA-and-oraquick-swab-test-/show/1891685).
Your take on this would be much appreciated. Do you think this is a false positive and I am negative? Again at 6 weeks I had a rapid and EIA test (negative), a rapid at 10 weeks (negative), and a rapid and EIA test at 86 days (negative). Is it possible that I do not have enough antibodies yet or is this just simply not the case?
MEDICAL PROFESSIONAL
Your repeat testing indicates that you do not have HIV and I would be most suprised if anythng else was going on here. PCR tests are well known to lead to false positive results and I suspect this. Sometimes false positive tests are transient and on some occasions they occur more regularly for reason that are unknown. I would suggest you find a local Infectious Diseases or HIV specialist to talk this through with. You need to know as much about this as possible in case it comes up again. As you do, please let us know what happens, we will all learn from your experience. EWH
Hi Dr. Hook,
I went ahead and got another test done at 113 and 86 days from the respective exposures described above. I had a rapid and an HIV 1/2 EIA test done and both tests came back negative.
I know that your stance is that anytime beyond 8 weeks with a standard antibody one is negative. I'm just concerned about the false positive at 76 days from the HIV RNA test (which, again, was not medically prescribed - rather, I was the one who asked for it), particularly because it did come at 76 days.
1. Am I conclusively negative?
2. Is the HIV RNA test a cause for concern or does this antibody test prove that it was a false positive?
3. How does a false positive HIV RNA test happen?
4. Is it possible that there just aren't enough antibodies but the virus is present?
5. Do you recommend further testing?
I went ahead and got another test done at 113 and 86 days from the respective exposures described above. I had a rapid and an HIV 1/2 EIA test done and both tests came back negative.
I know that your stance is that anytime beyond 8 weeks with a standard antibody one is negative. I'm just concerned about the false positive at 76 days from the HIV RNA test (which, again, was not medically prescribed - rather, I was the one who asked for it), particularly because it did come at 76 days.
1. Am I conclusively negative?
2. Is the HIV RNA test a cause for concern or does this antibody test prove that it was a false positive?
3. How does a false positive HIV RNA test happen?
4. Is it possible that there just aren't enough antibodies but the virus is present?
5. Do you recommend further testing?
MEDICAL PROFESSIONAL
1. False positve means that the test thinks it detects low levels of virus in the specimen from you. In fact this is a test error. There is no reason to think virus is at all present in you and we believe that the test is giving wrong results.
2. No need for further testing after your next standard antibody test. it will be negative.
3. Results any time more than 8 weeks after an exposure are reliable. EWH
2. No need for further testing after your next standard antibody test. it will be negative.
3. Results any time more than 8 weeks after an exposure are reliable. EWH
Thanks so much for the information.
Just to clarify (pardon the limits that come with conversing over writing):
1. When you say "Typically the false positive results show very low levels of virus (<100)" do you mean that I have low levels of HIV virus in me personally and that's what triggered the result, or do you mean that as a generality and that ANY virus can set off the test? I had a flu shot 12 days prior to requesting the HIV RNA test so I'm not sure if maybe something like that can set it off. Obviously if there's low levels of HIV present then isn't that a cause for concern?
2. Provided that a standard rapid test at 90 days comes back negative, should I continue testing beyond that?
3. Finally, I know you say that the antibody test is reliable at 6-8 weeks and since I tested negative at 6 and 10 weeks, should I be confident that I'll be negative at 90 days or is this PCR test a cause for concern?
I don't mean to over-post, I just want to know if I should forget about this, chalk it up to a fluke, and know that I'm healthy.
Just to clarify (pardon the limits that come with conversing over writing):
1. When you say "Typically the false positive results show very low levels of virus (<100)" do you mean that I have low levels of HIV virus in me personally and that's what triggered the result, or do you mean that as a generality and that ANY virus can set off the test? I had a flu shot 12 days prior to requesting the HIV RNA test so I'm not sure if maybe something like that can set it off. Obviously if there's low levels of HIV present then isn't that a cause for concern?
2. Provided that a standard rapid test at 90 days comes back negative, should I continue testing beyond that?
3. Finally, I know you say that the antibody test is reliable at 6-8 weeks and since I tested negative at 6 and 10 weeks, should I be confident that I'll be negative at 90 days or is this PCR test a cause for concern?
I don't mean to over-post, I just want to know if I should forget about this, chalk it up to a fluke, and know that I'm healthy.
MEDICAL PROFESSIONAL
Welcome to the Forum. I'll be happy to try to clarify things. Your experience is precisely the reason that we recommend against PCR testing for HIV diagnosis. The HIV PCR is a wonderful tool for helping to determine how well therapy is working in persons proven to have HIV but unfortunately does occasionally yield false positive results in persons who do not have HIV, causing great consternation and anxiety. Typically the false positive results show very low levels of virus (<100) while untreated infection leads to HIV levels in the thousands, tens of thousands or even millions.
The exposures and subsequent testing you had provide further confidence that your PCR is falsely positive. HIV is not transmitted through kissing, mutual masturbation, and receipt of unprotected oral sex. Thus your exposures were truly safe even if your partner did have HIV which,. based on his test results were not the case.
Thus, in summary, your PCR test is almost certainly falsely positive and should not concern you. In the future, I suggest that you use other tests for HIV, EWH
The exposures and subsequent testing you had provide further confidence that your PCR is falsely positive. HIV is not transmitted through kissing, mutual masturbation, and receipt of unprotected oral sex. Thus your exposures were truly safe even if your partner did have HIV which,. based on his test results were not the case.
Thus, in summary, your PCR test is almost certainly falsely positive and should not concern you. In the future, I suggest that you use other tests for HIV, EWH
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