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Weak–positive ELISA, Indeterminate W. Blot

Hi Dr. HHH/Dr. Hook,

Here's my scenario: the last time that I had sex was 9 months ago in Aug 2008. I have only ever had sex 4 times: once definitely with a condom, the next two times I'm not sure if I was protected or not [drinking] but found condoms in both cases the next morning, and the last time in Aug was [stupidly/drunkenly] with a sex worker, protected, orally and vaginally. In Oct 2008 I had full STD/HIV testing done. No STD's were found but the HIV test result came back as a "weak–positive" much to my horror and has since had me worrying DAY IN, DAY OUT. I gave more blood so the test could be repeated. Doctor also gave me a rapid blood test that was negative and the second lab test came back the exact same as the first. The labs evaluation was HIV negative, but since I was in the window period I didn't take the doctors negative rapid or the labs evaluation as gospel.

I've gotten 3 OraQuick rapids since (free, local clinic): once in Dec 08, Feb 09 and the end of Mar 09 – all were non-reactive, Negative.

I decided I needed a firmer answer and got a Western Blot as I read this was advised for people with a reactive ELISA. I got the WB this Tues and got the result on Fri – that result was: Indeterminate! One band came up, p31, which was down as "equivocal", the rest of the bands were absent. I read that p31 is a high HIV band so anxiety is really setting in.

The lab that did the WB said that another test should be taken in 4-6 weeks but since it has been 9 months shouldn't I be totally through any seroconversion by now? I've read that after an indeterminate WB, a PCR test next? Since the last time I had an ELISA test was when I was in the window period, maybe I should get one now? Although I would be very nervous to get another at the thought of it being reactive again, it would still be better to have a clear answer.

Many, many thanks in advance!
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Avatar universal
Hi Doctor, not sure if theses are OK to do, but a quick update since we last spoke: infectious specialist sent me to have another ELISA, got the result back literally five minutes ago and both HIV 1 & 2 after 9 months, came back NEGATIVE. I really feel as though this is a second chance and rest assured I will never act foolishly to put myself at risk ever again. Thank you helping me out and easing my nerves. I'm forever indebted. Many thanks.
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Avatar universal
congrats on your -ve test result :) i wish you the best of luck.
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Western blots are read visually, i.e. a lab tech examines a test strip looking for bands, which are simply a color reaction at the sites where the various HIV antigens "stick" to the test trip.  Imagine a faint band instead of a clear and sharp one, maybe so faint the technician isn't sure there is anything there at all.
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Avatar universal
You're right, around the $300 mark. An expensive lesson! Won't get tested again, feel a lot less tense now and will be seeing infectious disease specialist this week.

I understand if you don't reply to this as I don't mean to be going around in circles, and if this is not in your lane of experitise that's fine – what's the difference between a band being equivocal and a band being present?

Anyway, thanks again, Doc.
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Visit your local health department STD clinic -- should be highly expert in HIV test interpretation and very low cost, maybe free.  Don't do any more tesing; take the results you have had then follow their advice whether or not to have any additional testing.

I can't resist one final comment about your choices in the absence of medical insurance.  My guess is you have spent $200-300 for HIV testing, maybe more.  A single visit to a knowledgeable provider, plus the smaller no. of tests s/he might have recommeded, probably would have cost no more, maybe less.  And as just implied, your local health department STD clinic is always a low cost, expert source of such care.  A word to the wise for next time!
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Avatar universal
Dr. Handsfield,

Thank you so much for you're speedy, informative reply. I really appreciate it. As I have no insurance I can't go to a health care provider but I am going to seek out an infectious disease specialist as you suggested as I think that is my best bet at easing my own mind totally at the moment.

After getting a couple of peoples advice post–Blot, and now yours, I'm starting to think that I am HIV negative, since 9 months later, there should have been way many more bands showing up on the Blot and not just one, equivocal at that, right?

Just one last question: do you think if before I went to a specialist and I got one last rapid OraQuick test and it was negative, that at the 9 month mark, that result would definitely reflect my status?

Again, many thanks Doctor.

Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the HIV forum.

You describe a sexual lifestyle and exposures that place you at essentially zero risk for HIV.  Most important, positive HIV ELISA with indeterminate Western blot usually does not indicate HIV infection.  It is true that this pattern can occur during HIV seroconversion.  I'm not an expert, however, whether a p31 band is particularly suggestive of a true positive WB.  Given that you had no possible exposures to HIV for several months before the WB was done, it seems you can be certain that you aren't infected.  However, these details are getting beyond my and Dr. Hook's expertise.

It usually is a mistake for anyone to be tested for HIV (or other STDs) by going directly to a laboratory, whether found online or elsewhere, for testing without direct advice of a personal health care provider.  And it was a mistake for you to be tested for HIV repeatedly in such a low risk scenario.  At this point, you need to find a primary health care provider then let him or her guide further testing; or, even better, seek out an infectious disease specialist or other professional with lots of experience HIV diagnosis.  In the meantime, I believe you have no significant worries that you really have HIV.

Good luck-- HHH, MD
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