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Positive Rapid Test but Negative ELISA test

Question: 

I am a 32 year old male. I had an unprotected vaginal sex in mid December 2015. On January 26th (roughly 5 weeks after the exposure), I started feeling fatigued and had flush face for no apparent reason. Two days later, I had swollen lymph nodes (only in the neck), sore throat and oral thrush followed by a 38.2 degree fever.

The doctor told me it was probably tonsillitis and a throat infection that has caused the fever. I was given penicillin injections ( 3 applications, 1 daily for 3 days, 800 mg each) along with Paracetamol (500 mg capsules, 2 times a day) and Anti-inflammatory medicines (600 mg capsules, 2 times a day) for 3 days. My fever was gone in 3 days but I still had mild swelling in the lymph nodes with some pain and discomfort. The doctor did not feel necessary for me to continue with the anti inflammatory drugs and told me that the swelling will heal naturally.

On February 4th 2016, I told the doctor about my exposure to HIV risk and he said that although he doesn't think that I have HIV but it was wise to do a Rapid HIV test. The test was called "DoubleCheckGold" HIV 1&2. I got the result in approx. 1 hour and it was POSITIVE.
However, they said that they need to do a confirmatory ELISA 3rd Generation test to confirm. The ELISA test came out NEGATIVE. They ruled out the earlier test as a "False Positive".
I was asked to take another test 3 months after the exposure to be sure.

2 weeks later, I started having irritable bowel and diarrhea. The doctor gave me Omeprazol and IBS related medicines because I had a history of gastritis. However, they did not help. I saw a Gastroenterologist and he did not find anything serious and told me that had Irritable Bowel Syndrome. The doctor also said it was possibly due to stress and anxiety because of my HIV tests or anti inflammatory drugs. I still had swollen lymph nodes but no sore throat or pain. The stomach symptoms improved with medications.

I took ELISA 4th Generation Duo Test on March 30th i.e. roughly 3 months and 10 days after the exposure and it also came out NEGATIVE. 2 days earlier, the girl I had sex with also showed me her Rapid Test (which she took on March 25th) results and they were negative. However, I still have slightly enlarged lymph nodes although the doctor says he cannot see any swelling/redness but it definitely feels slightly bigger than normal. I also get flush face especially while eating. My blood test also showed that the percentage of lymphocytes was 15% and the normal range is between 20%-40%. According to the doctor, it was not something to be concerned about.

At this point, should I consider this test as conclusive or should I take another test in 3 months to be sure?

Answer: 

Hello,

Thank you for contacting the AIDS Vancouver Helpline as your source for HIV/AIDS information. I am sorry to hear about your confusing situation and I would be happy to help by clarifying some things.

First, I would like to say that it is certainly possible for false positives to happen. False positives can happen if you are not within the window period for test you are getting. For the rapid test, the window period is 4 weeks to 3 months. Your test is 6 weeks after your last high risk exposure and is within the window period time frame. However, all HIV tests are considered conclusive at 3 months after the last high risk exposure to prevent false positive results. A false positive may also happen because the rapid test is an HIV sensitive test that detects the presence of HIV antibodies. However, there are times when other substances in our blood can be mistaken as an HIV antibody, leading to false positives. The rapid test is used only as a preliminary test and if found positive, further confirmatory testing is required to rule out the possibility of a false positive and confirm HIV status. Confirmatory testing is usually done using a Western Blot or PCR NAAT Test.

With this said, it is good that you have had further testing using the 3rd Generation ELISA and 4th Generation Duo test. While neither of these tests are considered confirmatory, the 4th generation test is very accurate and reliable when done after the conclusive time period. Since your 4th generation test was done after the 3 month time period, this result is considered conclusive.

Please note that there are 4 situations where an HIV test would not be considered conclusive at 3 months. These 4 situations are if you are:

  1. Receiving treatment for Hep C
  2. Receiving chemotherapy
  3. Have an underlying immunodeficiency
  4. Have taken Post Exposure Prophylaxis

In the case of the first 3 situations, testing at 6 months is recommended for conclusive results. In the 4th situation listed, testing at 3 months after your last dose of PEP is considered conclusive. If you do not meet any of these things, then your test at 3 months is conclusive and you are HIV negative. If you do meet these things, please partner with your Doctor to have repeat testing at 6 months.

To address the sexual encounter that you had recently, please know that all of your HIV tests are based on the sexual encounter you had in December. As far as the sexual encounter you had in December goes, you did not contract HIV. While you did not state if your recent exposure was unprotected or protected, I will state that unprotected intercourse is considered a high risk for HIV and protected intercourse is considered a low risk for HIV. To know more about the HIV risks, please see the links provided. If you are concerned about the intercourse you had 2 days after your last HIV test, please know that you will need HIV testingagain to rule out the possibility of having contracted HIV from this exposure. AIDS Vancouver recommends that all sexually active people be tested on a regular basis for all STI's and HIV to ensure their sexual health and well-being.

With regards to your symptoms, please know that HIV has no clinically definable symptoms. This means that HIV symptoms vary from person to person with a common symptom of newly infected individuals being flu-like symptoms. However, having the flu does not mean that you have HIV. The only way to know if you have HIV is to get tested. Which you have done and have been found to be negative based on your exposure from December 2015. If you symptoms continue to concern you, please partner with your local medical professional to determine a cause and if needed, receive treatment.

I hope I have answered your questions and that you feel better! Please feel free to contact us if you have any more questions.

Best wishes,

Mary

AIDS Vancouver Online Helpline
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