[Question #7309] Oraquick - Faintly Reactive Test Line

6 months ago
Dear Doctors:

I've been dating a new woman for the last few weeks.  I have been previously tested this year for HIV with a 4th-generation lab test, which was negative.  I've not had sexual intercourse with anyone in about 8 months.  My new partner and I anticipate becoming sexually intimate soon and we decided that she would take an Oraquick saliva fluids test over the weekend.

Unfortunately, her test result was confusing.  Although not completely reactive on the Test line, there was a very faint red mark about one-quarter of the way across the line.  It was very subtle but noticeable.

My partner has not had sex with anyone in about 11 months.  She is 50 years old and would not be considered in a high risk category.  We live in the Midwest United States.  She does have a diagnosis of Lupus and takes hydroxychloroquine on a daily basis.  Just today, we went and had her tested with a lab-based blood test, but will now have to wait 2-3 days for test results.

Have you seen this type of situation before with an Oraquick test?  Does an autoimmune condition raise the possibility of an indeterminate result like this?  Would this raise the possibility of a false positive on her 4th generation test, which would require RNA testing to confirm?

Needless to say we are both very concerned.  We have engaged in mutual masturbation at this point but no oral or insertive sex.  If she is positive, should I be tested based on the contact we've had so far?

Thanks for your help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
Welcome back. I'm happy to see that this question is not a repeat of your previous ones!

Unfortunately, I can't give you the conclusive answer you seek. It sounds like your prospective new partner is at little or no risk of HIV. Therefore, the odds are very strong that her equivocal Oraquick test result is false, that she doesn't have HIV. I haven't heard of this happening with Oraquick, so I can't say how often such results may be -- but weak positive results, almost always false, do occur from time with other HIV antibody tests. Are you sure you carefully followed the instructions? Especially the time at which you read the result? A faint line might show up on a negative specimen if read later than recommended.

The best approach is for her to have a lab-based AgAb (4th generation) blood test. If negative, as expected, you can rely on the result. Alternatively, you could repeat the Oraquick test; if clearly negative, I would consider that result conclusive. However, most likely it would show a similar outcome, so there's a good chance this approach would just prolong your (and her) uncertainty and anxiety. An AgAb test result in most labs can be available in under 24 hours. (Another option of course would be for her to see a physician in person, preferably one with substantial experience in HIV diagnosis. But if that were an easy option, I imagine she would already have done this.)

I hope these comments are helpful. She really should be relaxed while sorting this out. In the early days of HIV testing, such false positive results were fairly common and we dealt with lots of questions about them on this and our preceding forum. No such cases in my experience turned out truly positive, either in the clinic or on the forum.

Let me know if anything isn't clear--    HHH, MD
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6 months ago
Dr. Hunter:

Thank you so much for your quick reply.  I will plan to update this thread after her test results are returned, hopefully the middle of this week.

On a different note, I happened to read a currently open thread on the forum about the possibility of spironolactone interfering with the results of HIV testing.  My girlfriend also takes this medication on a daily basis.

Assuming the results of her pending test turn out to be negative, is there anything else we need to worry about?  I'd really like to be able to put this behind both of us and move on with confidence.

Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
I had never heard of spironolactone interfering with HIV testing. After looking at the open thread you mention, I did a quick search of the medical literature. That questioner was mistaken. There is a single report that spironolactone may inhibit the ability of HIV to infect certain cells in laboratory experiments. That effect has nothing to do with testing for HIV or the reliability of the standard blood tests. In fact, there are no medications or medical conditions -- none, despite the kinds of BS anyone can post on the internet -- that interfere with the current HIV blood tests, with the single exception of anti-HIV drugs themselves delaying positive results.

You definitely can put this behind you once you confirm your partner's negative results by AgAb test.
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6 months ago
Dr. Handsfield:

I just wanted to update the thread and let you know that my girlfriend indeed received a negative result on her 4th generation test earlier this week.  I very much appreciate your advice under the circumstances.  That's the first time I'd ever seen anything like that with the Oraquick test and it was pretty upsetting for both of us.  Needless to say, we'll be sticking with lab-based tests should any need ever arise again in the future.

Thanks again.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
That's good news! I'm not surprised, of course, but it's good to hear it.

That concludes this thread. I'm glad the discussion was helpful. Take care and stay safe (both sexually and coronavirus!). 
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