[MCOH-EH] HIV 4th gen positive, Western blot negative

Jeff Jacobs, MD jacobjef at einstein.edu
Tue Jul 1 19:24:29 PDT 2014

Our hospital switched to the 4th gen HIV Ab/Ag test about 1 year ago and I encountered the following situation a few days ago. 

We saw an employee that was bitten by a source that had blood in their mouth. Source SBFE panel was negative for all (HIV, Hep B and Hep C) but the employee's baseline HIV Ab/Ag test was positive. A Western blot came back a day later and that was negative. The employee denied use of iV drugs and seems like a pretty health-conscious guy, for what that's worth. The only other abnormality on his labs were elevated AST/ALTs but again he denied alcohol use. I'm seeing him back early next week and have spoken with him a few times about this situation, most recently today at our clinic. 

I spoke to the UCSF PEPline and they suggested that we draw an HIV viral load PCR soon and re-test the 4th generation HIV test in 3-4 weeks on the employee. Their concern is that sometimes the 4th generation test picks up recent HIV infection sooner than the Western blot and they felt that this process would rule that out. Interested in your thoughts. Thanks. Jeff

Jeffrey A Jacobs, MD, MPH
Medical Director
Einstein LiveWell EHS
1303 Tabor Rd
Philadelphia, PA 19141
FAX: 215-456-1840

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