[Question #7286] false positive fifth generation hiv test?

6 months ago

Hi Doctor

Thank you so much for your time in advance. I'm going through a crazy situation and for some reason it's impossible to make an appointment with an ID doctor here in the US. 6 weeks ago I went for a normal check up blood work with my primary care, I didn't have any specific risk exposures but as a part of my check up he just included all of the tests including HIV. My blood was apparently sent to a lab that does fifth generation hiv tests with biorad bioplex 2200 which gives the results separate from each other and mine came back repeatedly reactive for hiv-2. Per algorithm they sent my blood to a reference lab and the multispot came back negative for both hiv1 and hiv2. no pcr was done. when I received my results 2 weeks had passed, I ran to aids care foundation and they tested me with two insti hiv1/2 . both tests came back negative. I went again in two weeks (4 weeks after my initial test) and the insti was used again and was negative again. As far as my risk exposures, I've been practicing abstinence for a year and a half. my last sexual exposure was unprotected oral sex with someone I'd consider low risk individual a year and a half ago and he also wouldn't be from an hiv-2 endemic. I had tested 5 weeks after that exposure with a fourth generation test and it was negative. I had two mole biopsies 3.5 month and one 5.5 month before my initial test and I went to a clean clinic I can't imagine anyone here reusing syranges!! I was using spironolactone 50ml for four months at the time of my test.

If I had hiv either of these exposures would show up in my insti hiv tests right??

I made a mistake of googling and found something about spironolactone inhibiting hiv infection is that correct? Is this maybe a case of late seroconversion because of spironolactone? I'm so confused.
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
Welcome to our forum and thanks for your question. I am sorry to hear of your false positive test for HIV-2. HIV-2 is very rare in the United States. Between 2010 and 2017 there were over 300,000 cases of HIV-1 diagnosed yet and fewer than 200 cases of HIV-2 in the same period.  In fact, a recent CDC report indicates that HIV-2 tests are falsely positive twice as often as they diagnose true infection.

Every test for antibodies occasionally has false positive results. Fortunately falsely positive test results for HIV of any sort or uncommon. The fact that you have additional tests for HIV-2 ( the INSTI tests) which are negative is strong evidence that your test results are falsely positive. If you were truly infected, the INSTI test, as well as the BIORAD test would have been positive.  You were just very unlucky.

You are correct that there is a single paper describing the possible inhibition of HIV replication in the laboratory by spironolactone. These findings however are of no clinical significance and should not worry you.  

I hope that the information I have provided is helpful. If there are further questions, please don’t hesitate to use your up to to follow questions for clarification. EWH
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6 months ago
Thank you Dr. Hook

To clarify the biorad fifth generation test was the one that was positive but multispot and three insti's were negative. When I found out about the spironolactone paper I actually stopped the medication and one of the insti tests is 3 weeks after stopping spironolactone. just couple of questions for you..

1-if it had interfered with my test previously would 3 weeks be enough for my body to elevate it's antibody response?
2-Should I do further testing at this point? I've seen people do dozens of retesting after having a false positive online but now having gone through this experience I really feel nervous to test further unless necessary.

3-Is the fifth generation test known to have false positives? I can't find a lot of info on it at all..

Best
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
Thanks for the timeline of your testing:

1.  Spironolactone is long gone a day after it is taking.  There is no way that your spironolactone would have influenced the results of your antibody test.

2.  From a scientific perspective, there is no need for additional testing.  If you choose to test again, please do it only once more.  The results are not going to change 

3.  
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Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
Oops too quick....
3.  EVERY test has false positives 

Please don’t worry.  EWH 
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6 months ago
Thank you doctor I really appreciate your time!

Best
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
I hope my comments and information have been helpful.  EWH---
6 months ago
Thank yo Dr.hook 

for my final test, I did go to a high end STD clinic center today and the drew my blood  from the vein and did and insti test which came back negative phew. Is that conclusive now? 6 weeks after my initial test?

unfortunately during my panic few weeks of reading countless articles I have no business of reading, I came across all sorts of things, one being elite controllers. an elite controller would still test positive for an insti antibody correct? I just want to put this behind me and not worry that some day I'm gonna have lab 4th gen test come back positive again.

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
Yes, your tests are conclusive and should be believed.  

Yes.elite controllers do have positive tests for HIV.

In situations such as this, the internet is not your friend.  Statements there are not filtered or fact checked and are all too often misleading.  All too much of what you’ll find there is out of date, taken out of context, or are just plain wrong.  Please stay away from the internet.

As I suspect you know, we provide up to three responses to each client’s questions.  This is my 3rd response and therefore the thread will be closed shortly without further replies.  Take care.  Please don’t worry and stay off of the internet.  EWH 
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