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re:Confusing lab results!!!!
Sep 14, 2010

Hi, doctor My name is Dr. amin. I am doctor internal medicine,MD from New Jersey. My patient asked you question bunch of time but he didnt receive any response. He insisted that i asked you this question. The patient is very close relative. Here is list of lab test results:

(Lab Corp)July 09, ICMA HIV 1/O/2, test positive, western blot negative. Viral load undetectable

(Quest Diagnostics)October 09, EIA test negative, western blot negative.

(Lab Corp)January 2010, ICMA test positive(3.33) western blot negative. Viral load undetectable

(Quest Diagnostics)March 2010, EIA test Non-reactive. CD 4 count 732, Percentage 32. CD 8 count 764 percetage 36. ratio is 0.92.

(Lab Corp)March 2010, ICMA test reactive 1.85, western blot negative. Viral load undetactable. cd 4 count is 674 percentage 29.9, cd 8 count 819 percentage 34.4 ratio is 0.81.

(Quest Diagnostics)April 2010, EIA non-Reactive, western blot negative.

(Lab Corp)August 2010, ICMA HIV 1/O/2 reactive, western blot negative. cd 4 count 592 percentage 29.9 cd 8 count 838 percentage 39.9. their ratio is 0.71

My knowledge is limited on this subject. I am assuming that he is negative but I cant be sure. I am seeking your help. One thing I dont understand is that why he is negative with quest diagnostics but positive tith lab corp. also if he is negative then why his cd 4 count is going low and low. does this indicated very rare strain of virus such as group o. My patient is going through tremendous anxiety..I hope to hear from you soon. Thanks!!!

Response from Dr. Young

Hello Dr. Amin and thank you for your post.

Your patient is HIV negative. Having a positive screening test (ICMA) followed by negative confirmatory Western blot is a negative test.

This follows the general principle that screening tests should have a higher rate of false positives, in order to have a lower rate of false negative results; in all cases, if possible, the screening positives should be confirmed using a more specific test (ie., the Western blot).

I hope this helps. BY

Thank you doctor for your answer. By the way his HIV EIA 2 is non reactive. do you think he needs western blot test for HIV 2.

1. Have you seen someone with low cd 4 count(592) and high cd8 count(832) and not have hiv?

2. do you think stress causing his cd4 count to go low and cd8 count to remain high?

thanks Deepak Amin, MD

Response from Dr. Young

Hello Dr. Amin and thanks for your follow up post (I lightly edited your question for purposes of confidentiality).

With a negative EIA for HIV2, there's no indication to have a Western blot performed. Indeed, almost by definition, screening tests are necessarily very sensitive- more sensitive than confirmatory tests (like the WB). So a negative screen predicts that the WB will be negative as well.

As for your other questions, a CD4 count of approximately 600 isn't low, it's normal. Further, a CD4:CD8 ratio of ~600/800 or 0.75 is also in the normal range.

I hope this helps, BY

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