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I Am A 30y M With No Significant Pmh Except

Posted on Thu, 24 Oct 2019

Question: I am a 30y M with no significant pmh except for chronically elevated wbc of 11-14k with chronically elevated lymphocyte count of 3-5. I’ve had chronic tonsillitis s/p adenotonsilectomy 8 months ago. Had a HIV 4th gen done which was reactive but subsequent hiv1/2 antibody was negative and hiv1 rna was negative. Approx 8 weeks later, I had taken a hiv1/2 ab test both of which were negative. How do I interpret this? Does this mean, I do not have hiv and that I need no further testing? Also thoughts on chronic lymphocytosis? Stress induced?? I’m always very worried and dehydrated. Remainder of CBC including hb and platelets are normal. If this is false positive 4th gen hiv, what is the likely cause? Thx for your help

Answered by Dr. Sankaranantham Murugan (8 hours later)

Brief Answer:
Lymphocytosis and leucocytosis are not common in HIV infection

Detailed Answer:
Hi,
Welcome to Ask A Doctor
Thanks for posting your query.
False positive with 4th generation HIV Combo test is very very rare. Less than 1%.
You had not mentioned anything about your sexual activities. Are you married or not?
Lymphocytosis and leucocytosis are not the features of HIV infection usually.
Rpeat the 4th generation HIV Combo test once again in another laboratory 12 weeks after your last contact or have western blot HIV test. That's more confirmatory.
Dr S Murugan

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Sankaranantham Murugan (46 minutes later)

If Hiv 1 RNA and antibody are negative, doesn’t that mean no infection? I’m married and monogamous.

Answered by Dr. Sankaranantham Murugan (4 hours later)

Brief Answer:
HIV qualitative RNA PCR is highly reliable for the diagnosis

Detailed Answer:
Hi,
Welcome back
Yes, you are right. HIV PCR is highly reliable and appear very early. All your tests other than the 4th generation HIV Combo test were suggesting that you are free from HIV Infection. There is every possibility that the 4th generation HIV Combo test could have error. Moreover you have only Monogamous relationship with your wife. Have you at any time had received blood transfusion?
Dr S Murugan

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sankaranantham Murugan (2 hours later)

Never had any blood transfusions and never used iv drugs. Do I need to repeat this testing again? Like I said 8wks I had this false positive 4th gen and then few days ago, negative hiv1/2 ab screening.

Answered by Dr. Sankaranantham Murugan (4 hours later)

Brief Answer:
HIV is very much unlikely in your case.

Detailed Answer:
Hi,
Welcome back.
I understand, There is no likelihood of HIV infection in your case.
Anyhow when a more advanced test came reactive once means, it will be very difficult for you to ignore and forget the same. In future, any small illness will make you think of HIV infection. So it will be better for you to see the non- reactive report of either 4th generation test in some other lab or to have nonreactive Western blot test. It is my opinion.
Dr S,Murugan

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar