[MCOH-EH] HIV 4th gen positive, Western blot negative
Hudson, T. Warner
TWHudson at mednet.ucla.edu
Wed Jul 2 11:38:12 PDT 2014
Here also is the full CDC document released a few days ago on the new recommended HIV lab testing. http://www.cdc.gov/hiv/pdf/HIVtestingAlgorithmRecommendation-Final.pdf
T. Warner Hudson, MD FACOEM, FAAFP
Medical Director, Occupational and Employee Health
UCLA Health System and Campus
Pager 800.233.7231 ID 27132
E-mail twhudson at mednet.ucla.edu
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Swift, Melanie
Sent: Wednesday, July 02, 2014 11:11 AM
Subject: Re: [MCOH-EH] HIV 4th gen positive, Western blot negative
Jeff, the 4th generation HIV test screens both for p24 antigen and for HIV-1 and 2 antibodies. So a positive could be due to antibody OR antigen. The 4th gen test picks up new infections when you only have antigen and no Ab yet. So diagnosis is maybe 2 - 3 weeks earlier.
There is an algorithm recommended for the confirmation testing process, attached.
(NAAT stands for Nucleic Acid Amplification Test - the viral load UCSF was talking about.)
BTW if you use this type of HIV test for your exposure followup testing, you can simplify the f/u regimen to baseline, 6 weeks and 4 months.
Hope this helps,
Melanie Swift, MD
Director, Vanderbilt Occupational Health Clinic http://occupationalhealth.vanderbilt.edu
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Jeff Jacobs, MD
Sent: Tuesday, July 01, 2014 9:24 PM
To: mcoh-eh at mylist.net
Subject: [MCOH-EH] HIV 4th gen positive, Western blot negative
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
Einstein LiveWell EHS
1303 Tabor Rd
Philadelphia, PA 19141
This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If you are not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any disclosure, copying, or distribution of this information is strictly prohibited. If you have received this message by error, please notify the sender immediately to arrange for return or destruction of these documents.
The MCOH-EH List is moderated by Joe Fanucchi MD FACOEM and Mike Band DO.
List membership is free, but only subscribers may post to the list.
To post send messages to: mcoh-eh at mylist.net
To become a subscriber, or to change your subscription options (turn off email while you're on vacation, etc): http://www.mcoh-eh.net
MediTrax / Occupational Health Systems, Inc. provides financial support to ensure the list remains a free resource for the occupational health community.
List archives (public): http://mylist.net/archives/mcoh-eh/
Send administrative requests to: drjoe at meditrax.com
IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by return email, and delete this message from your computer.
More information about the MCOH-EH