Wife Tested Positive - Question

[HoldingOntoFaith]

I'm going to post a question on the doctors forum but they're already at their limit today. My wife and I had our first child yesterday. She tested 3 weeks ago for the required HIV yet and was negative.  When they tested before delivery, it was a positive result. You can imagine what we're going through. She says she hasn't had any other sexual partners and I believe her. Naturally, I then thought about myself and an experience I had in a Mexican strip club 3 months ago. It was low risk, (head of penis might have rubbed against her underwear) but the thought is still there.

So I immediately went out yesterday and took a Home Access test which came back today as negative. They sent my wifes off to get a Western Blot test but it won't be back for a week. The doctor thinks it's a false positive.

My question is this, what are the odds that I am a carrier, infected my wife 2 months ago (the last time we had sex) but still don't show antibodies today? It just doesn't make sense.

As you can imagine we're concerned about our daughter who has to stay on treatment until my wife and her blood tests come back.

Would you assume my Home Access at 12 weeks is definite or is there a chance that I could have given it to her a couple months ago but still test negative?

[Vance2335]

I really don't know why it is taking so long to get this to a conclusion. You have negative tests, she now has negative tests. You are both negative.

Unless someone is not telling the truth...you are wife about exposures.

[HoldingOntoFaith]

Teak, we want to believe that but it's not like I'm freaking out about nothing here. She tested positive and indeterminate on the western blot. An ID can't confirm that she's negative. It's scary. Cut me some slack here.

[Teak]

How in the world could your wife be positive without having an exposure? Either she cheated on you or she didn't. You don't have HIV and she didn't get it from thin air.

[HoldingOntoFaith]

Just got back from the ID OBGYN and we're anxious all over again. He recommended that my wife stop breastfeeding and get our daughter back on the medication. Apparently, the Viral Load was not conclusive enough for him because the WB had an indeterminate result due to the p24 weak reaction.

He had her give blood for a p24 antigen test. I'm a little unclear, but I'm assuming that he's taking that test because there could be a chance that she could have antigens in her blood and the viral load would be less than 20 copies. (which is what the RNA test went to)

Here are a couple of questions in my mind right now:

1. Would there ever be a case where the viral load was less than 20 copies and she did have HIV antigens in her blood?
2. What would that window period look like? Based on what I've read, it sounds like that is a small window and would only be the case if she was exposed 1-3 weeks prior? (she hasn't had intercourse in 8 weeks)
3. If the first positive test detected antibodies or antigens, why wouldn't the Oraquick have picked it up later in the week? (he dismissed the Oraquick saying it wasn't that reliable although he might have meant it's not that reliable in this case because it wouldn't pick up antigens)

He said that if the results of the p24 antigen test come back negative, then that's enough for him to sign off on a false positive. Until then, he can't be sure.

[joggen]

False positives on a rapid test aren't really that rare when you take into consideration the level of potential risk. If rapid test has 99.6% specificity, then 1 out of 250 tests will be falsely positive. For a typical heterosexual encounter with someone of unknown status, the risk of contracting HIV is 1 in million. So any individual under this testing protocol who has a typical exposure is 4000 times likely to have a false positive result than a true positive result. And that isn't even taking the elevated risk of false positives that can occur during pregnancy into consideration. That is something that an infectious disease pediatrician should take into consideration whereas a regular pediatrician would not. Hopefully he will give you the closure that you need tomorrow.

[HoldingOntoFaith]

By the way joggen... with regards to your question about them giving her another test, it seems like that is the new requirement now.

One test in the first trimester, one test in the third trimester and then hospitals always run one right before any surgical procedure (which is the one that was reactive).

This article from 2000 seems to be extremely consistent to what we're going through. Hopefully, if someone in the future runs into this same problem and reads this thread, this will explain a few things.

http://archfami.ama-assn.org/cgi/content/full/9/9/924