Positive Elisa---Indeterminate Western Blot

[BlueJay2011]

I was tested for HIV on February 25.  I received a call indicating that the initial test was positive and my Western Blot return indeterminate and that I would need to be re-tested in 4-6 weeks.  I recently began a sexual relationship with my best friend of 14 years (who does not have sex with men as far as I know and is not an intravenous drug user) who tested negative in April of last year (prior to a surgery) and February 1st of this year.  I tested negative in November of last year.  We have had at least 4 (February 14, 18, 21, 23) occasions in which I could have been exposed.  I've called the clinic twice to ask questions and during the last conversation the nurse practitioner told me that my Western Blot test did not reveal any HIV band were absent and the one equivocal band would only pose a problem if I have had sex with someone from West-Africa. (Which band would that be) However, she didn't tell me exactly which band was equivocal.  If this is the case, why was my Western Blot not ruled as a 'negative' as opposed to 'equivocal'?  Is there a possibility that I could be seroconverting? I haven't had a high fever (99.1 being the highest for about two hours--this could possibly be due to menstruation) I've had neck, back and leg aches...  

I retest in about two weeks...Please help!

[unknown284]

Thank you Dr. EWH!
This puts my mind at ease.  However, I don't think I can fully relax until I see the results in black & white!

Thanks again!

[Edward W Hook, MD]

Glad we could help.  Take care. EWH

[BlueJay2011]

My 3rd and final Western Blot: NEGATIVE!!!
Thank you Dr. Hook for ALL of your help.
What you do here is AWESOME and VERY helpful!

[Edward W Hook, MD]

I predict tthat you will either have a negataive test or another indeterminant. Either way, I see no need for further testing to rule out having gotten HIV.  Take care. EWH

[BlueJay2011]

Last question:

I'm going in for my last retest (3rd Western Blot). (My bf tested negative again in March 30)  If it comes back indeterminate (10 weeks and 1 day since initial test), can I safely put this behind me?  Or, do you recommended that I have more tests by an infectious disease doctor?  I would like to avoid incurring any unnecessary expenses.

Thanks for all of your help Dr. Hook!

[Edward W Hook, MD]

I understand how troublesome an interdetminant result can be but the additonal comments you make do change in my assessment.  Your results do not suggest a lingering infection but a false positve test result.  EWH

[BlueJay2011]

Good Morning Dr. Hook:

I do apologize for bothering you.  I've tried to put this behind me but my anxiety will not allow me to do so.  I've read instances where people have tested indeterminate twice but on the third WB, they received a confirmed positive.

1.Since I've only had a p18 (equivocal) band react on both tests (5 weeks interval between tests), do you think it's possible that I could be experiencing delayed seroconversion or;

2. even seroconverted on the sixth week following my last test?

It's been three three weeks since my second indeterminate WB and I'm a bit worried.  I have a canker sore on the base of my gums (could be due to the stale pretzel that got lodged between my gums and lip and scratched my gums the day prior to the canker sore forming) and I have little fine bumps on my arms--not sure if it's a rash but it's only noticeable when I look very close.  No fever or other "symptoms".  

I think I've been pretty safe.  I have not had ANY sex since my exposure prior to my initial testing.  

3. Dr. Hook, do you think that I can be confident that my next test on May 3rd (with the infectious disease doctor) will either return the same or be negative?  

I told myself that I wouldn't make myself CRAZY over this situation, but it's easier said than done.

Thanks Dr. Hook

[Edward W Hook, MD]

This is not bad news, it indicates that you have the bad luck to have an indetrminate ELISA for HIV.  It does not suggest that you have HIV.  EWH

[BlueJay2011]

Additionally,
I cannot get an appointment with an Infectious Disease doctor without having first been diagnosed as HIV positive.  I do not have a primary care physician as my insurance recently changed...
What are my options for further testing?

[BlueJay2011]

Dr. EWH:

Results from my follow-up are in.  My results are still indeterminate... :o(
The results are exactly the same!
Help!

[Edward W Hook, MD]

No need for more money.  All of this is compatible with the false positve process I describe above.  I urge you not to worry. EWH

[BlueJay2011]

Just obtained a copy of my results

HIV 1/O/2 1.11 High <1.00
all bands absent
p18 equivocal...how significant is the p18 band?

I will gladly donate more $ to have this question answered.  

[Edward W Hook, MD]

I would not hazard a guess as to which band was positive and you should not waste your time worrying about it. EWH

[BlueJay2011]

Thanks Dr. EWH:

Additionally, the nurse practitioner told me to put this test to the back of my mind and not to worry.  She told me to take it as a "goof up" and come back in for retesting in 4-6 weeks.  I guess that I'm worried that she could be wrong (because there is always room for human error).  

One more question:  When I asked which bands were present,
She responded:  "They were absent sweetie."  She then proceeded to ask me "Have you had sex with someone from West Africa?"  "Have you had sex with someone who has had sex with someone from West Africa?"  My response was No.  She then stated "Well, you have no need to worry about this one equivocal band".

Just out of curiosity,  do you know which band this could be?  
Anxiety is really getting the best of me...

[Edward W Hook, MD]

Welcome to the Forum.  A very small proportion (less than 1%) of persons have antibodies which cross react with some of the proteins contained both in ELISA and Western blot tests for HIV. As a result these persons have positive or equivocal ELISA results and when the Western blot is performed, typically only a single of many possibly reactive protein bands reacts in the test.  In contract when a person has antibodies to HIV infection they make antibodies to many bans an many band react.  In a VERY small proportion of such cases this is because antibodies to HIV infection are just beginning to form and when tested later, more bands are positive making the diagnosis definitive.  In much such case, including yours, in all likelihood, either the single band is no longer reactive or it remains the same and additional bands are not reactive.  Given your history and situation, I suspect you are one of those persons who has the bad luck to fall in this equivocal state who does not have HIV.  Follow up testing is good idea but I would predict that your test will either remain equivocal or be negative. Either result will prove that you do not have HIV.

In addition, it you are seroconverting (unlikely) you could re-test  in a week or two. I see no need to wait for 4 weeks.

I hope this explanation makes sense. I realize it is a bit complicated.  EWH