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Negative RNA, indeterminate western blot
Hi there,

I'm quite anxious about HIV test results. I'm a male and had a low risk exposure with another guy. Anal frottage where he pushed hard against my anus but as far as I can tell did not insert. If there was insertion it was not deep (I never bottom so think I would tell if it was significant) and there was no ejaculation, just precum.

At both 18 and 33 days after exposure I had negative RNA results. However also at 33 days there was a positive Elisa with indetrminate western blot.

I'm incredibly anxious and confused. I thought RNA was pretty accurate since it looks at the virus not antibodies. But I also read that wb is the gold standard.

The indeterminate wb is confusing.
How common are inderminate results? Could it be that I'm seroconverting but that my viral load is very low/not detectable?
I will get more testing but looking for some ideas in the meantime,

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1 Answers
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239123 tn?1267651214
Welcome to the forum.  Thanks for your question.

The large majority of indeterminate HIV Western blot results are in people without HIV; and if you were one of the rare exceptions, your HIV PCR (RNA test) would have been positive.  Also, not all indeterminates are the same; depending on the details of the WB result (specifically, which antibody "bands" are apparent), the lab generally can tell whether an indeterminant result will prove to be positive or negative.  Probably this information was reported to your doctor; but if s/he is uncertain, s/he could contact the lab directly to sort it out.

Equally or more important is your negative HIV PCR (the RNA test).  That result, combined with an indeterminate WB, almost certainly means you don't have HIV.  HIV appears in the blood, and its RNA is detectable by PCR, well before antibody develops and can be detected by ELISA or Western blot.  Since you had negative PCR results (twice) before the positive ELISA and indeterminate WB, the most likely explanation is that the latter results are the false ones.

Your exposure risk level really is irrelevant at this point.  The test results tell the story.  You correctly understand that this was a low risk exposure, but even with a maximum risk exposure (e.g., if you had been topped by an HIV positive partner who ejaculated in your rectum), I would still trust the test results.

I'm not sure exactly how frequently indeterminate WB results occur.  It's well under 1% of all persons tested for HIV, however.  As suggested by my comments above, it is very unlikely that you are infected.  However, I agree you should be retested until absolutely definitive results have been obtained.  The additional testing should be guided by an HIV/AIDS expert; if your not under the care of such a specialist, you should ask your current provider to refer you to one.  (That specialist will also know how to interpret your indeterminate WB, i.e. whether it's suspicious positive or probably negative.)

Finally, of course all this assumes you have had no other potential exposures of any kind (e.g. a regular partner) since the frottage event you have described.

I'll be interested in hearing the outcome when all is said and done.  In the meantime, stay as relaxed as you can.  Although test results like yours can be alarming, it is very unlikely you have HIV and I expect confirmatory testing to prove it.

Best regards--  HHH, MD
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239123 tn?1267651214
University of Washington
Seattle, WA