[Question #13058] HIV Preliminary Reactive Again
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2 months ago
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I tested preliminary reactive for HIV on my latest Ag/Ab screen again (first time was in Nov 2024). Like last time, the HIV 1/2 AB Differentiation and the HIV 1/2 Qualitative RNA tests came back as non-reactive with a final interpretation of "HIV antibodies were NOT confirmed and HIV-1 and HIV-2 RNA was NOT detected. No laboratory evidence of HIV infection."
Here is my recent test history:
- March 1, 2024 = negative HIV Ag/Ab screen (no risk factors for more than 3 months prior and always negative before that, too)
- Nov 12, 2024 = preliminary reactive Ag/Ab screen but negative confirmatory tests (no risk factors for more than 11 months)
- May 23, 2025 = preliminary reactive Ag/Ab screen but negative confirmatory tests (no risk factors for more than 18 months)
The repeated negative confirmatory testing gives me some comfort and makes be think this is a false positive, but I have the following questions (one for peace of mind and a couple for clarification):
1) This is a false positive, right? Can I rely on the confirmatory tests to mean I am definitely HIV negative?
2) If I am HIV negative, why on earth is this happening?
3) I have HSV-1 and HSV-2. Could those be contributing to false positives?
4) Could the test being used be to blame?
I will be discussing these tests with my doctor, but any information you can provide on how to interpret these results or possible causes for this pattern would be greatly appreciated.
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Edward W. Hook M.D.
2 months ago
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Welcome to the Forum. Thanks for your questions. I'm sorry that your combination HIV antigen/antibody test is once again falsely positive From your post, it appears that you are taken this frustrating situation in stride and if that's the case, I complement you. Your tests do prove that you do not have HIV. If you had HIV both your HIV PCR and antibody tests would be positive. FYI, it appears that the portion of your tests which is falsely positive is the p24 antigen assay, not the test for HIV antibodies. Falsely positive tests are uncommon but among false positives, it is the p24 antigen test which appears to be move commonly positive. In answer to your specific questions:
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1) This is a false positive, right? Can I rely on the confirmatory tests to mean I am definitely HIV negative?
Yes, believe the confirmatory tests.
2) If I am HIV negative, why on earth is this happening?
Great questions but no good answers. Many but not all falsely positive tests are transient. Something in your blood reacts with the p24 antigen portion of the tests you have been tested with. This may be related to the specific test or some unknown characteristic that you have. The chemistry behind different tests varies from test to test so it would be interested to know if both of your falsely positive assays came from being tested with tests from the same manufacturer. If both your false positives occurred with the same brand/manufacturer, it might be worthwhile to get tested with a tesst from a different manufacturer.
3) I have HSV-1 and HSV-2. Could those be contributing to false positives?
There are no proven associations between having HSV and falsely positive tests.
4) Could the test being used be to blame?
This is possible. See my response to question 2.
I hope this information is helpful. I appreciate how frustrating this must be. EWH
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2 months ago
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Thank you for the quick reply, Dr. Hook, and for the kind words about taking this frustrating situation in stride. I assure that I was much less composed before I got my response from Dr. Handsfield the first time this happened. I am grateful to you both for the quick, clear advice. I will trust my confirmatory tests and continue with confidence that I am, in fact, HIV negative.
Some resources online suggest that recent vaccinations might contribute to these false positives. Aidsmap, for instance, states: "Less commonly, false positive results may occur in people who have recently had a vaccination or have an autoimmune disease (such as lupus)."
I did receive a flu vaccine shortly before my first false positive. Is there any literature that suggests that might be a contributing factor? I am not aware of any other health issues that might contribute to this situation (like lupus), but I'll definitely discuss that with my doctor.
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Edward W. Hook M.D.
2 months ago
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There are no clear answers to your questions. Persons with high levels of circulating antibodies such persons with lupus or rheumatoid arthritis appear to have modestly elevated risk for falsely positive antibody tests. Whether vaccines do the same thing is not clear and as you know there are a lot of people who blame vaccines for many problems without strong scientific evidence. In your case however, this would not explain a falsely positive p24 antigen test, nor would a recent vaccination explain why your tests are repeatedly falsely positive.
I certainly would not avoid recommended vaccines because of your situation. EWH
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2 months ago
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Understood. I definitely did not plan to hold off on vaccines. I was just looking for possible causes for this unhappy pattern.
Just to close this thread out, can you confirm that these are the correct take-aways from our conversation?
1) The reasons for false positives are unknown, but my confirmatory tests are definitive. I am HIV negative
2) No additional testing is needed.
3) This might continue to happen, but as long as I don't have any new risk factors it is not a concern.
I will follow up on any other questions with my doctor. Thanks again for all your help.
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Edward W. Hook M.D.
2 months ago
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To confirm:
1) The reasons for false positives are unknown, but my confirmatory tests are definitive. I am HIV negative. Correct
2) No additional testing is needed. Correct
3) This might continue to happen, but as long as I don't have any new risk factors it is not a concern. Correct. As I mentioned above, it might be helpful to find out if your falsely positive tests occurred using the same test. If that was the case, their may be value for testing with a test made by a different manufacturer.
I hope the information I provided has been helpful. This thread will now be closed. Take care. I wish you the best. EWH
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