Possible false positive - quietly freaking out

[Hopeful123]

This is my first time posting here and after talking to a select few loved ones about my situation and after reading through various posts here, I feel safe speaking about the situation I am currently experiencing.

I have been on PreP since the beginning of 2017 and have always adhered to my daily dosage maybe missing 1 or 2 doses in the beginning of my treatment. I get an STD panel done every 3 months and my HIV results have always been non-reactive however I did test positive for syphilis in June of 2017. I got a penicillin shot and ever since then my syphilis test have always come back non-reactive as well. I had an STD panel done on Nov. 12th 2019 and both syphilis and HIV were non reactive.

Recently I had my 3 month STD panel done on Feb. 4th and my HIV and syphilis test both came back reactive though I tested negative for both HIV 1 HIV 2 antibodies, however the results said there wasn't a sufficient quantity of blood to run an HIV RNA test. Between November 12th and Feb. 4th I have had 3 sexual encounters that were unprotected anal sex where I was the bottom (1 partner I've been with for years) but I have been taking my PreP daily as usual which I know is only 99% effective against HIV transmission. I haven't had any symptoms of HIV, not even a cold, but I also know sometimes symptoms don't show at all. My doctor gave me a few options as to what these initial results could be: I am HIV positive and the reactive result is an early detection and my body just hasn't had time to produce antibodies, I may have another virus (not HIV) in my body that the Ag/Ab test picked up on, or I did come into contact with the HIV virus but my truvada medication fought off the infection...however we won't know until the HIV RNA test come back and viral load results. I've gone through the crying, cursing, wondering why me and blaming myself for thinking PreP is a definitive shield against HIV and now I am trying to make myself ok with the fact that I may in fact be one of those few cases who has contracted the virus while on PreP. I've been taking Truvada for 3 years now so I know HIV meds is pretty much the same routine (1 pill a day) but I am just so scared to actually face the reality of being an HIV positive individual. Is there a chance this could be a false positive test? Is this a common occurence, being on PreP and contracting the virus?

[Jim Allen]

Hiya,

Firstly stop beating yourself up.

Not sure I follow the recent results correctly, so the initial screening was reactive AB/AG test, I presume on the p24 and then you had antibody differentiation immunoassay that was none-reactive for HIV 1 & 2 antibodies?

Anyhow, I'm really sorry to hear about the reactive result, I can understand its a shock however false reactive results on screening tests is something we see here nearly monthly so relax and simply get the confirmation testing done to confirm your negative or positive HIV status.

If the result is positive, well at least it's been detected early, before any major damage is done and given the testing history and PrEP usage it would be from within the last 6 months.

Here's what you need to know in order to avoid hiv infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions. Continue taking PrEP in the future as an additional layer of protection against HIV

Keep in mind that some sexual practices which may be described as ‘safe’ in terms of HIV transmission might still pose a risk for transmission of other STI's, so please do get fully tested regularly and test more frequently if unprotected intercourse occurs

Also, note that it is possible to have an STI and show no signs or symptoms and the only way of knowing is by testing.

Kind regards

Jim

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[Hopeful123]

Thank you for the kind words, I am trying to not beat myself up but it is rather hard not to do because I feel as though my life is about to change in the blink of an eye because of my own stupid negligence. To clarify the results, yes it appears I've tested positive for the p24 antigen but the differentiation showed negative for both HIV 1 and HIV 2 antibodies and the interpretation for that was negative. I saw a chart that you posted on another posts and am I too understand that if my results come back the same again (reactive for p24 antigen but negative for the antibodies) and my viral load is 0 that there is a chance I can still be HIV negative? And am I correct in understanding that if my PreP has failed that I came into contact with a mutant strain of HIV that's immune to truvada? (which I've read is how people on PreP contract the virus which seems to be a rare occurence).

Seeing as how I have never shown symptoms I feel as though now I'm just waiting around to get sick or start showing rashes, any little sneeze or cough I say to myself "Am I starting to seroconvert"? The fact that I'm a slight hypochondriac doesn't help this situation but being able to talk here has helped.

[Jim Allen]

Hiya,

I saw a chart that you posted on another posts and am I too understand that if my results come back the same again (reactive for p24 antigen but negative for the antibodies) and my viral load is 0 that there is a chance I can still be HIV negative?

Would that be this one prehaps or something similar? - https://stacks.cdc.gov/view/cdc/50872

Simply wait for the results and focus on living your life as normal in the meantime. What you posted so far would indicate either an early infection so you are testing within the window period or more likely run of the mill false reactive result on screening test. To be honest, if you had a low VL result I would suspect a false result and recommend waiting and retesting.
 

And am I correct in understanding that if my PreP has failed that I came into contact with a mutant strain of HIV that's immune to truvada? (which I've read is how people on PreP contract the virus which seems to be a rare occurence).

I understand the question but let's scrap mutant from your vocabulary. No two HIV infections are the same, the virus in each person would be slightly mutated, that's not an issue. The issue with PrEP is it's not 100% to start with and then comes into play factors like if the strain of the virus has resistance to the meds, adherence issues, level of drug in the tissue (absorption) etc etc etc.

Seeing as how I have never shown symptoms I feel as though now I'm just waiting around to get sick or start showing rashes, any little sneeze or cough I say to myself "Am I starting to seroconvert"?

Most common is to have no initial symptoms or none noticeable, waiting around for them is a waste of time and also not a good place to be with your thoughts. Try to put it out of your mind and focus on something more productive.

[Jim Allen]

how people on PreP contract the virus which seems to be a rare occurence

Just to add although, I stopped counting/tracking this mid-2019 the answer I gave  someone 6 months ago about PrEP and overall my stance remains the same. Nothing is 100% all the time and PrEP is just 1 layer of prevention, however, it's got a very solid track record so far.

PrEP is highly effective, although it's not a guarantee. I've counted about 31 cases of PrEP failing from earlier case reports, although more recent cases include drug level testing, the trend were seeing in new cases are mainly suboptimal drug levels i.e not taking the drugs as prescribed or an odd few drug resist strains causing PrEP to fail.

Overall PrEP remains highly effective although no guarantee.

Try to relax. 

[Hopeful123]

Good afternoon,

So after a very difficult 6 days of waiting for my confirmatory results these are the results I received today online.

HIV - 1 RNA by PCR = <20 and then under it says "HIV - 1 RNA not detected"
log10 HIV - 1 RNA = Unable to calculate result since non-numeric result obtained for component test
HIV Genosure PRime(R) = Not indicated

RPR = reactive
RPR, Quan = 1:2
Treponema Pallidum Antibodies = reactive

HIV Screen 4th Gen wrfx = non reactive (my initial test on feb. 4th said reactive but negative on both HIV 1 & HIV 2 antibodies)

I don't see my doctor until Thursday afternoon but over the past 6 days I think I've read over a thousand articles and from what I'm seeing does this mean I'm negative and the first results were a false positive? (possibly due to the syphilis infection OR the virus being present in my system but my Truvada stopped the infection)?

From what I understand the RNA test is saying there were less than 20 copies in my blood stream which could be 0-19 but there weren't enough for them to detect HIV in my blood? And I'm unsure of what the log10 HIV RNA is but since there was a non-numeric result does that mean my RNA level is 0?

The Genome test is a resistance tests to HIV medication from what I researched (I may be wrong) but since it was "not indicated" I take that means my body isn't resisting my Truvada and its working properly?

Lastly the 4th Gen test being non reactive in this test, does it mean that there were no antigens or antibodies detected meaning that I am in fact HIV negative?

I know my doctor said I will have to get tested for in 6 weeks and than 6 weeks from that just to make sure but for the meantime I just wanted to get a second opinion.

[Jim Allen]

I said I would post a longer reply so here it is.

The result you have would indicate HIV negative. Do talk to your doctor as well to go over the results. 

The Genome test is a resistance tests to HIV medication from what I researched (I may be wrong) but since it was "not indicated" I take that means my body isn't resisting my Truvada and its working properly?

No, and I feel this is an important one to clarify. This is resistance testing, but it's not testing to see if your body is resistant to something and it's no indication of PrEP working for you or not.

The results of this test had you acquired HIV and had a viral load of over 500 copies would have indicated if the HIV was resistant to any treatment and assisted your doctor in determining what treatment regime going forward would be effective in keeping it suppressed.

I know my doctor said I will have to get tested for in 6 weeks and than 6 weeks from that just to make sure but for the meantime I just wanted to get a second opinion

Yeah, sure. Peace of mind and testing to rule that you are within the window period.  I'll add as a reminder to continue to test routinely going forward so at least every 3 months as PrEP users should be doing.

I don't see my doctor until Thursday afternoon but over the past 6 days I think I've read over a thousand articles and from what I'm seeing does this mean I'm negative and the first results were a false positive? (possibly due to the syphilis infection OR the virus being present in my system but my Truvada stopped the infection)?

I'm sorry that this situation stressed you out to the point of reading thousands of articles. The indication from the start was simply a false p24 reaction. 

However, the result you have had would not be due to HIV being in your system and Truvada somehow stopping it, as having truly detectable levels of HIV antigen in reaction to HIV infection on a screening test would mean you would be infected and no amount of PrEP or HIV meds would undo an HIV infection at that stage.

Cross reaction to another past or present infection is the most likely explanation of the majority of false reactive screening tests. They are highly reactive tests but not very specific, hence there is always follow-up testing and the follow-up antibody differentiation immunoassay yielded negative indicating testing within the window or a negative result.

No need to continue reading up on this point or overthinking it.

From what I understand the RNA test is saying there were less than 20 copies in my blood stream which could be 0-19 but there weren't enough for them to detect HIV in my blood? And I'm unsure of what the log10 HIV RNA is but since there was a non-numeric result does that mean my RNA level is 0?

HIV - 1 RNA not detected

In short, no HIV 1 copies were detected and the test is has a limit is down to 20 copies. However, if you had 19 copies in your system, the result could have read "HIV detected" but it would have been below the threshold to correctly quantify. 

Anyhow, the point is HIV-1 was not detected and to confirm the repeated HIV 1/2 screening test was non-reactive.

I've gone through the crying, cursing, wondering why me

To be honest when I first read this, asides from appreciating the shock and emotions you must have been going through, I also thought "Well, why not?" HIV is just a virus at the end of the day, it's doesn't care about who it infects, nothing more to it.  Thankfully though, you have a negative result.

Finally, I know I've already said all this before but I feel it's worth repeating, as there is a possibility that someday you might have a similar result.

False reactive screening results do happen, they are highly sensitive tests but not very specific, neither are they a diagnosis. The way to interpret a reactive result is the test simply could not confirm a negative result and have follow-up testing to confirm. Although I can understand this can be a shock, it's always best to remain calm and not to overthink things.

Take care, best, Jim.