Hello,
Thank you for choosing DoctorSpring. Welcome back.
You might remember that I have already answered you consult. Hence I have forwarded this consult to 3 other Doctors- Dr.Gautam Banga Urologist, Dr. Jacob George Pulmonologist with expertise in treating TB and HIV, and Dr. Naashoma Pereira Family Physician.
I will coordinate and consolidate the replies soon and post it here.
My answer to your concerns are the same - Yes that result was indeed false positive and you need not worry about it. Repeat testing is not needed.
Thank you.
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Additional Replies :
Dr.Jacob George :
Hello,
Regards from doctor spring.
I have gone in detail through your mail and reports.
It seems the test indeed was a false positive test. You are unlikely have HIV infection in view of the repeated negative tests. Still to be sure you can go for a repeat test.
Hence my opinion will be to re check the viral load 1 or 1 more repeat antibody test.
regards
Dr. Jacob George P
MD, FCCP
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Reply by Dr.Gautam Banga
Urologist.
Hello and thankyou for approaching DoctorSpring with your query. Our panel of doctors have gone through your case and have discussed it detail. We will first answer your questions and then explain it in detail to you.
1) This is definitely a false positive result. RNA PCR can have upto 5% false positive results
2) No further testing is required in view of all the test you have done and all have come negative
3) No other tests are required as the test you have done are very sensitive, and have come negative on all occasions (beside RNA PCR which is not used as a diagnostic test)
First of all the chances of you having got an infection was negligible.
Because insertive oral intercourse (penis in mouth) and kissing have very low risk of HIV transmission. Plus your partner did test NEGATIVE for HIV 66 days after his previous sexual encounter. Nor do you have other risk factors like STI’s , drugs or anal intercourse that would put you at a higher risk.
In view of the above itself the fact that your RNA PCR was positive goes to say it was a FALSE POSITIVE.
Secondly RNA PCR has can give upto 5% false positive results, which is why it is NOT used as a diagnostic test and is only used to monitor viral load in patients who are on treatment.
However all false positive results have HIV RNA less than 2000 copies/mL making them easily distinguishable from true positives who have HIV RNA values more than 10,000 copies/mL.
Your results have 415 copies/mL which definitely proves that it is a FALSE POSITIVE result.
Thirdly your have done multiple tests and all have come negative.
The latest being 217 and 190 days from the exposure which makes it 7 and 6 months from your last exposures. You have tested negative on rapid and EIA 7 and 6 months from the exposure which rules out any chance of infection and requires NO further testing. Nor do you have any symptoms.
You can close this chapter and put it behind you carrying on with a happy and healthy lifestyle.
I hope this has helped and cleared your doubts. Feel free to follow up.
Wishing you all the best.
Thankyou
Patient replied :
Hello doctors - thank you for your input. I have some follow-up questions:
1. All have said no more testing is needed except Dr. George. My most recent rapid and EIA test (the one at 217 and 190 days respectively) was 6 days ago. Does this change his opinion on needing more testing? It's just a bit disconcerting that he would suggest more tests and if he does recommend more tests I would like an explanation so I can understand why.
2. Will Dr. Naashoma Pereira still be responding to the case?
3. Do you think it's necessary to have another STI panel done to check for other STIs? I had one at 69 and 42 days respectively as I said and everything was negative and I have never had any itching, redness, swelling, lesions, warts, penile discharge, pain or burning while urinating. I just want to effectively rule out everything...
4. This has been a very stressful and anxious time. Is it normal for your patients who do get false positive tests to seek psychologic treatment? I cannot stop thinking about this.
Consult reply from Dr.Naashoma Pereira Carvalho . Further replies from Dr.Jacob George Awaited.
Hello,
I have gone through your question in detail.
My opinion on this would be that you are Negative for HIV, as you have tested negative for rapid and EIA multiple times.
Since your last test was done 217 and 190 days from the last exposure rules out any chance that the test might have come negative cause of the ‘window period’. HIV window period is between 6 weeks to 3 months. By window period I mean, that a person has the HIV virus but antibodies have not developed. HIV antibody tests usually become positive within 6 weeks and definitely by 3 months of the individual being infected with the virus (the window period). You have tested negative at 7 and 6 months from your exposure which rules out any false negative for EIA.
RNA PCR is known for its high false positive rates and hence is not used as a diagnostic test.
In view of the multiple negative rapid and EIA tests and you have no symptoms , I would say you have no reason to worry.
The positive RNA PCR test is a false positive as the values are very low. Ideally a true positive should have values above 10,000 copies/ml.
This is a false positive result and No further testing is required.
I hope this has helped.
Thankyou
Patient replied :
Thank you Dr. Sebastian -
While awaiting an answer from Dr. George, I had two questions for you:
1. Do you think it's necessary to have another STI panel done to check for other STIs? I had one at 69 and 42 days respectively as I said and everything was negative and I have never had any itching, redness, swelling, lesions, warts, penile discharge, pain or burning while urinating. I just want to effectively rule out everything...
2. This has been a very stressful and anxious time. Is it normal for your patients who do get false positive tests to seek psychologic treatment? I cannot stop thinking about this.
Hello Travis,
I understand your situation. I really do. You will be surprised to know a lot individuals suffer from constant anxiety and worry from suspicion of possible HIV infection. We call it HIV neurosis. Most cases the HIV tests will be repeatedly negative and still the individual keep worrying.
In your case it is different. You had one false positive result and so it is natural to be concerned about this. Yes you can consider psychological or supportive therapy. And NO you DO NOT need any further tests.
I don't think going for a Medical Board was also good idea. Now you have asked 3 Doctors and obviously there will be difference in opinion. Like Dr. George's reply I am posting below. I do not agree with his consult reply bytheway.
I would say you are much much more likely to be in a road traffic accident (god forbid) than being diagnosed with an HIV. Because of this are you going to stay inside your home for ever ? You need to get into the reality. It is called 'false' positive for a reason. The good thing here is that you have insight. Insight that your are over worried and being paranoid. That also means the issue can be tackled.
So IMHO you do not need any more tests.
Feel free to followup the conversation.
Thank you
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Consult Reply : Dr.Jacob George.
Dear Patient,
HIV and STI are a sensitive issue and it has to be dealt with extreme delicacy and privacy, with pre and post test counselling. we should get to know facts about the disease, likely positive hood of the result, its implications and also abt negative. as it is a very sensitive issue, we have to be cent percent sure in giving a advise, affirmative or not. i understand you might have a decent knowledge on this topic because of google. Thats why the previous reply was cut short and abrupt. i do apologize for the same. so here is my point of how things are.
1st- risk stratification - mutual masturbation to pleasure is associated with a low risk, however oral sex and any sex with involvement of delicate mucous membranes have a higher risk.
your partner was tested negative, around 66 days after his previous affair. now does that mean he is disease free?
after contraction of the disease, our body tries to resist the disease by producing antibodies against the virus / bacteria and its these antibodies that are usually tested as a screening test. However in HIV, the time taken for antibodies to develop is 2 weeks to as late as 6 months. so a negative test in the initial period does not rule out disease. so a negative test result of your friend does not seem reassuring to me.
similarly in your case. Enzyme-linked immunosorbent assay (ELISA) is usually the first test used to detect infection with HIV. If antibodies to HIV are present (positive), the test is usually repeated to confirm the diagnosis. If ELISA is negative, other tests are not usually needed. if ELISA is positive on repeated occasions, we ask for a Western blot - which is more difficult than the ELISA to perform, but it is done to confirm the results of two positive ELISA tests. i would have contented and reassuring you against wasting time, money and peace of mind in fearing you have contracted AIDS with all these negative eia reports you got. however you have done another test - a PCR - which makes me thiink twice against reassuring you. Polymerase chain reaction (PCR) is a test that finds either the RNA of the HIV virus or the HIV DNA in white blood cells infected with the virus. though not done as frequently done as EIA this test may be done in the days or weeks after exposure to the virus. Genetic material may be found even if other tests are negative for the virus. The PCR test is used by us to find a very recent infection, determine if an HIV infection is present when antibody test results were uncertain, and screen blood or organs for HIV before donation. in your result i find that the virus copies are present which means to me that there is virus multiplying in your body, and your body has not started producing antibodies against it. or maybe you are having a HIV 2 virus and are being tested for HIV 1 virus ( though this is a rare situation).
so what would i like you to do? i would like to believe the PCR report is false positive( chances are very low as its a quantitative report, unlikely elisa, where you get innumerable false positive tests), but confirm that belief by proving there is no virus load in your body on a later occasion, or the viral load has not increased from its previous value.
its with this in mind did i suggest a repeat testing of PCR and to seek guidance of an infectious disease specialist.( i disagree with the doc you have already met, as EIA being false positive / negative is more plaussible than a pcr being false positive)
hope i have cleared your doubts.
feel free to ask if anything more is unclear.
wishing you good health
Dr. Jacob George
MD, FCCP
Patient replied :
Hi Dr. Sebastian
Thank you for your help. I find it reassuring that you and two other doctors have all said the same thing except Dr. George who not only kept the conversation curt because I could apparently google my answer but also seems unknowledgable about this issue as he himself even recommended I see a specialist. His answer is not only unhelpful but provides further confusion and is a disservice - if he is unknowledgable about this, why is he being consulted? I have posted my reply to Dr. George below - please let me know if you disagree with any of my points. I just want to be declared conclusively negative and move on. Thank you.
First, my EIA tests were EIA tests with reflexes, meaning that if they were positive they would have been checked by a Western Blot. All of my EIA tests were negative. All of my rapid tests are negative.
Second, my EIA tests screened for HIV 1/2 and again, they were all negative.
Third, most leading HIV specialists in the field like Dr. Edward W. Hook and Dr. H. Hunter Handsfield say that today, at least in the U.S. with current antibody tests being used, 6-8 weeks provide conclusive results with the maximum time being 3 months. In fact, the U.S. Center for Disease Control states it takes 3 months.
Fourth, PCR tests are not approved for diagnosis and screening in the United States and are known to produce more false positives than a standard antibody test. Further, false negative tests on any test are far more unlikely than a false positive test. And I do not know how you can think that one can get 10 potential false positive antibody tests.
Finally, as the doctors have stated here (and as I have seen elsewhere by other doctors) all false positive results have HIV RNA less than 2000 copies/mL making them easily distinguishable from true positives who have HIV RNA values more than 10,000 copies/mL.
Hello,
I do realise and acknowledge Dr.George might not have been the best person to be in the medical board for your consult. Our peer review team will look into this and take necessary action. As per our policy we do not interfere in a Doctor's consult reply and we will post the reply without modification even if the other board members disagree. This is to keep the platform as neutral and unbiased.
I have forwarded your reply to Dr.Jacob George. I feel it is better if we close the consult with Dr.George for the time being (as I see no productive outcome in this case). I will assign a new Specialist in your case and get back to you with additional replies.
Thank you