Faint test line on Rapid Blood Test post-Traumatising Incident

[AnonymousAnxiety]

Hi, I am a bisexual and had receptive anal sex with a few partners (with condoms and they're all tested HIV negative) for a while prior to August 2019.

In August 2019 I attended a party in which I was drugged by another man (which I am not certain of his HIV status) and he forced himself on me against my will. I was conscious during the rape and was really helpless and couldn't fight back as I couldn't move. I suffered depression after and felt so humiliated that I couldn't confide in anyone after the incident.

It was then a week ago in May 2020 (I did not have sex since August 2019 because of the trauma), I finally have the courage to open up to my best friends and they encouraged me to go to a local sexual health clinic for a test.

The clinic used the Alere Determine HIV-1/2 Ag/Ab test (finger prick) - in the results the test line appeared to be faint and the doctor described the result that the test line looks like it is “reluctant” to show up and he later referred me to a Western Blot test.

I wonder, if the faint line mean anything? Could it be a false positive?

A month after the incident my brother was struck with an influenza-like viral fever that lasts for 7-8 days and it spreads throughout the family and post-fever I had a sore throat (the one with ulcers in the throat) that I have never have before.

I am very anxious and worried ahead of the WB test result and I couldn't stop blaming myself for what happened.

[Jim Allen]

Hiya,

Firstly, I'm sorry to hear about the assault and the pain it's causing you but glad to hear you have supportive friends. This was not your fault and, you have nothing to be ashamed about.

I would also urge you to also talk to your healthcare provider about the assault as they should be able to provide you with details on any additional support services.

[Jim Allen]

Regarding your HIV results, it's a reactive result.

The thing to keep in mind is this is not a diagnosis, the screening tests are sensitive although not very specific meaning false reactive results on screening tests happen plenty.

I understand the Doctor has already ordered a WB test so all I can encourage is to remain calm and wait for the results.

Kind regards

Jim

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[AnonymousAnxiety]

Hi Jim,

Thank you so much for your response and I appreciate and thank you again for your acknowledgement and advice.

In all honesty, I am really afraid and scared. As in, what are the odds/chances that I would be tested positive on the WB test? (I am pretty sure he did not ejaculate in me though I wouldn't deny that there will be pre-seminal fluid). I read across the Net that the finger prick Alere Determine is by far the most accurate rapid test.

About the faint line, is it true that the intensity of the line is dependent on the HIV antibody/antigen count in the body? If it's true, shouldn't it be a darker colour line considering the high risk happened in August 2019 and by now the antibody count should be high?

Oh and another, apart from the worst sore throat ever that took place a month after the incident - I did not observe/experience any discomforting symptoms tallying to the ones of HIV (except for some rashes but I have rashes that runs in the family and it started since young).

Many thanks in advance for your response and apologies if my questions sounded absurd. I'll update here when I receive my WB result.

[Jim Allen]

You're welcome.

As in, what are the odds/chances that I would be tested positive on the WB test?

There really isn't a way to really give you any realistic odds.

About the faint line, is it true that the intensity of the line is dependent on the HIV antibody/antigen count in the body? If it's true, shouldn't it be a darker colour line considering the high risk happened in August 2019 and by now the antibody count should be high?

If the end result is positive and that remains to be seen, the antigen count would have dropped off already to below detectable levels if the event in August was the exposure and a lighter antibodies line on screening kits can happen for a number of reasons and isn't an indication of higher or lower levels.

In all honesty, I am really afraid and scared. As in, what are the odds/chances that I would be tested positive on the WB test? (I am pretty sure he did not ejaculate in me though I wouldn't deny that there certainly will be pre-seminal fluid). I read across the Net that the finger prick Alere Determine is by far the most accurate rapid test.

Yeah, I can appreciate this is a lot to digest when you already have plenty on your plate.

However, let's not get ahead, right now you should be presuming the result will be negative and the follow-up testing is simply just to confirm. Also, if the end result is positive it's certainly not something you will have to deal with alone. 
 
All the approved HIV antibodies finger-prick tests have just about the same high sensitivity. Like I said false reactive results happen, so far it's just a reactive test to something in your blood and cross-reaction to other antibodies or substance etc happens, hence the more specific follow-up testing.

Soon you will have the result and the wait will be over, in the meantime try as much as you can not to focus on this.

[AnonymousAnxiety]

Hi there,

After a few days of disbelief, anger and shock - I have now decided to update my test results here as promised in my thread in this forum to seek help and advices. So I received the result of my WB Assay on June 7 (confirmed HIV positive) and here goes as tabulated below:


Western Blot Assay Results

DETECTED	NOT DETECTED
gp160 (Env Band 160)	p55 (Gag Band 55)
gp120 (Env Band 120)	HIV-2
p66 (Pol Band 66)
p51 (Pol Band 51)
gp41 (Env Band 41)
p31 (Pol Band 31)
p24 (Gag Band 24)
p17 (Gag Band 17)

Interpretation: POSITIVE Anti HIV-1 status
Interpretation criteria: Detection of 2 ENV and GAG or POL.


On June 12 I attended a follow up whereby I was asked to do further tests which cost about 2355 dollars (approx. USD550) (I did in a private clinic therefore medical services and medicines are not subsidised by the Government):

• Lymphocyte Surface Markers
• Package Screening (Full Blood Count, Blood Film, Liver Function, Glucose, Renal Function, Lipid Profile, and Urine Feme)
• RPR(VDRL) including titre and TPPA if positive
• Toxoplasma Serology-IgG
• HIV-1 RNA Viral Load

The doctor also recommended that I start the HIV treatment (daily 1 tablet). The given antiretroviral medicine was Trustiva (bottle of 30 tablets). A single dose consist of 600mg Efavirenz, 200mg Emtricitabine, and 300mg Tenofovir. One bottle of it is about 550 dollars (approx. USD130).


Of the 5 tests I have received results of two:


Rapid PCR for HIV-1 RNA Viral Load Quantitative
Specimen Type: Plasma
Viral Load: Not detected


CD4 CD8 Report
White Blood Cell Count: 6.2
Reference Range: 4.3 - 10.5

Lymphocyte Count: 2.4
Reference Range: 1.5 - 4.6

CD3 Count: 1993, 83%
Reference Range: 988 - 3260, 53% - 80%

CD4 Count: 480, 20%
Reference Range: 431 - 1976, 31% - 46%

CD8 Count: 1428, 59%
Reference Range: 385 - 1805, 17% - 49%

CD4/CD8 Ratio: 0.34
Reference Range: 0.92 - 3.41%

Interpretation: Absolute counts of CD8+ and CD4+ within normal limits. However, the CD4+/CD8+ ratio is low.


As from the results shown above I have just a few questions:

• As the high risk exposure was last year in August 2019 which would be at least 41 weeks from my WB test, how was it possible that my p24 antigen could still be detected? (I learned that p24 would usually disappear a while or fall to undetectable level).
• After 41 weeks, how could my viral load still stay undetectable and my CD4 stays within normal limits?
• What does it mean when my CD4+/CD8+ ratio is low?
• The doctor did not provide clear answers to my questions and doubts and continuously insisting on the above testings. Is it recommended if I do another rapid test and confirmatory test elsewhere to confirm my status?
• I read from the Internet that a good CD4 count would be at about 500 - what are the factors that would decrease CD4 count in both HIV positive and negative people? Can unhealthy lifestyle be one of them? (Due to constant work and stress, my average sleeping time is about 4-5 hours a day and I'm usually on alcohol in the weekends; I only exercise once a week)
• As mentioned that I was recommended to go on Trustiva, any opinions on the meds?
• I have skin problems that runs in the family - eczema - which is considered as an autoimmune disease and also very susceptible to conditions that runs in the family like High Blood Pressure and Diabetes. Could that have influence anything in the HIV testing process?
• I am constantly on business trips abroad and so with the adherence to HIV drugs it is going to be a problem. What are the advices of travelling with meds to stringent policies on medications and HIV like Australia and China?
• Being undetectable, will I still be able to conceive a child through natural means without infecting both my future wife and child?

These are the questions I have for now. Thank you so much in advance for your kind patience in responding and assuring. I will update the thread with any further test results soon. Sincerest apologies once again if my questions turned out to be ridiculous.

[Jim Allen]

Hiya,

Sorry to hear about the positive WB test following the reactive screening test.

Just to let you know I will reply in detail to your post shortly, however, I am working at the moment.

Briefly on the Viral load test result, could just be a faulty test or the levels are below the threshold for that test, depends on exactly what test was used.

Best, Jim

[AnonymousAnxiety]

Hi Jim,

Thank you for responding.

Regarding the Viral Load test: the test used for the Viral Load was the Cepheid GeneXpert Real-Time PCR Xpert HIV-1 Viral Load Assay. It's designed for rapid detection and quantitation over the range of 40 to 10 x 10^6 copies/ml.

Thank you once again and I will be looking forward to your reply.

[virgo313]

Hello AA,

If you can mention which country you are from then other may be able at reply (Q no6). Not all country have full range of HIV medication.

Scenario: in my country where poz treatment is free, almost everyone goes to gov hos.
As such private clinics or hospital do not really have “specific ID department” & as such do not “hold” latest hiv meds. Let me be blunt... they care for $$ also.

Just wonder if you would like to share ur location & some may/can chime in. Tks

[AnonymousAnxiety]

Hiya @Jim Allen,
Just an update on this thread of the results of my other health tests - all is fine and within healthy levels. Not that I am doubting my rapid and confirmatory tests but I have expected the worst and apparently besides the positive diagnosis all my other body functions and levels are within the healthy range.


Hello @virgo313,
I am from Malaysia

Gov hospital here do subsidise treatments too but a few HIV+ friends have said treatment at public hospitals are not as good as private ones - they give more than one dosage and there's occasionally incomplete treatments and above all - the stigma. Nevertheless, I do plan to switch to a community sexual health clinic nearby, there're pretty good reviews on the treatments provided there.

(PS. Malaysians, do come out and convince me that I was given the wrong info!)

[virgo313]

Hi AA,

I guess correctly that you are Malaysian. Exchange rate of 4.28 to 1USD.  I am too Malaysian. KL. In terms of medication, you are getting generic drug/med. Original is called Atripla. This is not one of the newer drug BUT it is a very good drug/meds. Some countries have discontinue using this because there are newer ones in market. This is what I mean private hospital clinics “done hold” all medication.

I am on the same medication like yours. The only difference is that it comes with 2 pills. “Adding both pills” it becomes Atripla (same as Trustiva). There will not be “extra dosage” when I take 2 pills instead of 1. (1 pill = Emtrib... + Tenof... / 1 pill is Efav...)

Previously, there is a post that a person seek treatment at Prince Court. The Dr that attended him/her was the same full time Head Dr at Sg Buloh. This is what I mean when I say most private Dr do not “open an ID department). Oc course they will promote them self as having an ID specialist. There are still those who will seek private treatment due to personal reasons. Do you want to get free meds or pay for it. This is your choice.

I agree there is some disadvantage going to government. I will be waiting time on the day of your appointment. The good thing is that I will be given all sort of check-up like eye & others every 6 months or once a year.

Hope these info helps. We are not “as advance” in terms of having new meds. However, our Dr are good esp those train in ID. Tks

[AnonymousAnxiety]

Thank you @virgo313!

It does help a lot.

[AnonymousAnxiety]

As from the results shown above I have just a few questions:

• As the high risk exposure was last year in August 2019 which would be at least 41 weeks from my WB test, how was it possible that my p24 antigen could still be detected? (I learned that p24 would usually disappear a while or fall to undetectable level).
  
• After 41 weeks, how could my viral load still stay undetectable and my CD4 stays within normal limits?
  
• What does it mean when my CD4+/CD8+ ratio is low?
  
• The doctor did not provide clear answers to my questions and doubts and continuously insisting on the above testings. Is it recommended if I do another rapid test and confirmatory test elsewhere to confirm my status?
  
• I read from the Internet that a good CD4 count would be at about 500 - what are the factors that would decrease CD4 count in both HIV positive and negative people? Can unhealthy lifestyle be one of them? (Due to constant work and stress, my average sleeping time is about 4-5 hours a day and I'm usually on alcohol in the weekends; I only exercise once a week)
  
• I have skin problems that runs in the family - eczema - which is considered as an autoimmune disease and also very susceptible to conditions that runs in the family like High Blood Pressure and Diabetes. Could that have influence anything in the HIV testing process?
  
• I am constantly on business trips abroad and so with the adherence to HIV drugs it is going to be a problem. What are the advices of travelling with meds to stringent policies on medications and HIV like Australia and China?
  
• Being undetectable, will I still be able to conceive a child through natural means without infecting both my future wife and child?
  

Heya am wondering if there’s any good souls here who could probably respond or provide any assurances to the questions above?

I know that it’s  best to refer to a healthcare professional; but I wonder if I could get more input from the wonderful people here in this forum.

The question regarding the medication prescribed has been removed from the quote as it has been attended to. Hopefully there’s someone here in the forum who could share something with me or help me clarify on some questions.

[Jim Allen]

Sorry mate had a few stressful family drama days here.
Anyhow, see below and feel free to ask your doctor as well if that helps settle the mind.

1)
P24 antigen usually drops off quickly, although it's all rather irreverent or I don't see how it's relevant. Is this a concern and why?

2)
My CD4's were within the normal average range for many years, you also have no idea what was normal for you before HIV and CD4 counts can jump even by 100 within the same day.

It's not very relevant once or if your CD4's are outside of the major danger zone and there is little you can do about it.  The % is higher than 14 and you have now started treatment to stop the slow losing fight with HIV. 

https://www.poz.com/basics/hiv-basics/understanding-lab-work-blood-tests

The VL could be the test was incorrect, this does happen. Could also be a number of other reasons, none of them to my knowledge would make any difference.

3

It's a single snapshot moment, following a recent infection and before starting HIV treatment. It could settle back closer to normal range with time, however, other than taking your HIV meds and trying to live a bit healthier there is very little you can do about this so no point stressing about it too much.

http://i-base.info/qa/5224
https://www.poz.com/basics/hiv-basics/understanding-lab-work-blood-tests

4
You have had a reactive screening test and positive WB - Until very recently and in some parts of the world this is still the gold standard and definite. If you are really worried and need additional reassurance talk to your or another doctor if possible about repeating the WB as an example for peace of mind.

5

Smoking may falsy increase CD4 counts temporarily, false economy.

Anyhow, smoking, excessive drinking and lack of sleep the least of your concerns should the CD4 count. This all damages your health in far more ways regardless of HIV status but now, in particular, it's a concern and something you should consider changing.

Smoking:
https://www.poz.com/article/1-4-smokers-successful-hiv-treatment-projected-die-lung-cancer
Those who adhere well to antiretroviral (ARV) treatment for the virus but smoke are estimated to have a more than 10 times greater chance of dying of lung cancer
compared with dying of AIDS-related complications.

https://www.poz.com/basics/hiv-basics/hiv-smoking
https://www.poz.com/article/attention-hivpositive-smokers-article-save-life
https://www.poz.com/article/people-hiv-tend-realize-much-smoking-shortens-life-span

Drinking

https://www.poz.com/article/alcohol-buzz-27115-1109
HIV Is Linked to Getting a Buzz on Less Alcohol
https://www.poz.com/article/safe-alcohol-people-hiv
How Safe Is Alcohol for People With HIV?
https://www.poz.com/article/even-one-two-drinks-day-can-harmful-people-hiv
The safety threshold for alcohol use is lower for HIV-positive people


6
No.

7
Business trips and taking a few pills a day really is not an issue, it's just something you need to adjust to. Many people need to take daily meds for conditions and travel.

As for travel restrictions, you can check here: https://www.hivtravel.org
Can't comment on China though, never been there. Most of my travel is EU/US and Africa.

8
You could conceive naturally, after 6+ months on meds with a maintained suppressed viral load, if you then keep taking your meds as prescribed. Some forum members have done this, alternatives are also your partner taking PrEP or sperm washing etc.

https://www.preventionaccess.org/consensus
https://www.poz.com/basics/hiv-basics/hiv-family-planning

Best, Jim

[virgo313]

Hi AA,

Since you mention that you plan to switch to a community sexual health clinic. I am guessing it PT. Just wondering if you have communicate with them if you will need to do all the test again? Thanks

[AnonymousAnxiety]

@virgo313

Yes it's PT, I have already been in contact with them and they said if I need further assurances/confirmations I can repeat the test to finalise and rest my doubts.

[AnonymousAnxiety]

@Jim Allen

Thank you once again for responding.

P24 antigen usually drops off quickly, although it's all rather irreverent or I don't see how it's relevant. Is this a concern and why?

I had this doubt about my WB test because many has told me that the test that I did should not have detected any p24 antigen anymore especially months after exposure as its dropped to undetectable levels (adding that my CD4 was in normal range and VL not detected); I think by now as you said, it's rather irrelevant at this point and there's possibilities too that my VL test could be incorrect.

Most of my travel is EU/US and Africa

Do you usually declare your medicine upon arrival or do you just walk through the "nothing to declare lane"? I have carried medicine abroad before for gastric and flu and usually walk through the "nothing to declare lane" and till date have never been called for random inspection; I'm not sure if I'm doing it right either.

[virgo313]

Travelling to other countries bring meds is most of the time is not an issue.
The thing here is “be truthful” when filling entry form/s. China form is very simple & will not have issues going thru nothing to declare.

Australia you will need to “tick” that you are bringing in medication. As soon as tick “yes” this means you need to walk to the “declare” lane. As you are Q’ing they may approach you and look at your card. They will most likely ask what medication you are bringing in. Just say it is for hiv & they may not check your baggage.

IF you tick “no” on the question, then you may get a fine for not declaring. The rule here is that if you declare & walk to the declare lane, the worst is that the will just confiscate the item (very often travellers bring fruits & dairy items)

Lastly, always carry your medication hand carry baggage.

[AnonymousAnxiety]

Just a quick update now that it's almost more than a month since my diagnosis; managed to transfer to another doctor and have my PCR and CD4 checked again. The rapid test kit shows positive but for the second time in another setting, PCR comes back undetectable and CD4 still within normal limits (I'm not on treatment yet; last exposure is in August 2019). The Doctor seems to be puzzled by the results and referred me to go for another test in a hospital: the Quantitative HIV 1 Antibodies Test.

He did raise an aspect that from his knowledge that I may be an elite controller but that requires thorough testing and observations and hence the first right step would be going for the test as mentioned. Meanwhile, I am asked to not commence any treatment first.

[AnonymousAnxiety]

Also, thank you, @virgo313 for your response.

Just a quick check if you've know any shared experiences or persons who are in treatment provided by the clinic run by PT? Just wondering as I couldn't find any reviews regarding treatment provided by the clinic online.

[virgo313]

Hi AA,
Sorry, I don’t have any contact at PT. I think it is best you make an appointment with them to do further test. Best still is head to a hospital as recommended by ur 2nd private Dr. I understand ur are not comfortable heading to government ones. But after seeing them you can always move back to a private or continue at PT.

As for elite controller, it is very rare. So don’t feel towards that direction first. My recommendation is Sg Buloh hospital if you keen to do follow up. Tks

[AnonymousAnxiety]

Hi all,

I'm not sure if it's alright to change a new subject in a new post on my old thread (for my personal and reader's reference of my story since being a PLHIV) or to start a completely new thread; but here goes.

It's been a couple months now and here's a quick update: I went to a Government hospital end July and was referred to a really kind and supportive doctor. My Viral Load was still undetectable again and the doctor gave me a choice to hold on longer or to start HAART immediately (he recommends this option) - with the support of my partner I decided to commence my meds. I was given Viraday as a continuation when my current Trustiva from my old doctor is finished.

I am really blessed to have moral support from my best friends and my partner throughout these few months. I feel less terrible of myself now and though sometimes I still find it hard in forgiving my rapist and moving on, I am starting to see the light at the end of the tunnel for me - a really big credits to everyone who have stayed with me throughout this journey.

Just a small two questions here though:

• My TB x-ray was a negative but the doctor still recommends Isoniazid as a form of preventive therapy. I'm not sure what this means despite explanations from him - would love to consult with you guys here if I should go with this preventive therapy?
• I set my medication time at 12.30am daily but sometimes due to working OT (happened only twice since July), at 12.30am I may still be driving on the road and I wonder if taking a little later (before the next hour as in before 1.30am) will affect drug resistance build-up?

Many thanks in advance and apologies to the moderators if changing the subject within the same thread goes against the guidelines - I'll move to a new thread if this is not acceptable.
[/list]

[Jim Allen]

Hiya,

Glad to hear your have started treatment, have support and things are getting better.

I set my medication time at 12.30am daily but sometimes due to working OT (happened only twice since July), at 12.30am I may still be driving on the road and I wonder if taking a little later (before the next hour as in before 1.30am) will affect drug resistance build-up?

Sure you should aim to have great adherence, however, an hour either side should not pose any issue. By all means, put this down as questions to ask your doctor as well the next time you see them.   

This is not an uncommon question when starting treatment, added a few links to threads with similar questions as an example.

Adherence?
https://forums.poz.com/index.php?topic=71153.msg

Adherence
https://forums.poz.com/index.php?topic=73377.msg

https://forums.poz.com/index.php?topic=64111.msg

Hope things continue to go well and keep us posted 

Best, Jim

https://www.aidsmap.com/about-hiv/adherence-hiv-treatment
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943894/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4839839/
https://journals.lww.com/jaids/Abstract/2019/11010/Antiretroviral_Adherence_Level_Necessary_for_HIV.3.aspx

[virgo313]

Good to hear that you are doing well. Also that you find that our gov hospital medical care is not actually bad. Best of all is that it is free thus u can save a lot.

Some info.
Collection of monthly med. After seeing Dr every 6 months, he/she will prescribe 6 months of meds (usually up to 7-8 month time into the system). Head to the hospital pharmacy to collect 1st month. I think you know this already.
You can also collect med the following months from another hospital that is nearest to your home or office OR they can post to you (Rm5 cost)

You can collect med 1 week before or after the collection date. If you collect “1 week early” always, this way I end up with some extra pills on standbys. Sometimes, our hospital will have limited supply & they will give our only 2 weeks. Good to hold some extra in case. You know lah, how much money our gov have. 😂
Hope these info helps.

[virgo313]

Ohhh. I forget to mention. In case you want to collect ur 2nd-6th month meds from another hospital, you need to advise the pharmacist during 1st month collection time & tell them which hospital you want to collect the following months, they will issue a slip for you to bring to that hospital to collect 2-6 month ones.