![]() The fact is that there is a 40-day delay from when “4th Generation” antigen/antibody combination test turns positive to when the Western blot does so. That’s a long time for a person not to know whether he/she has HIV, especially since this is the most contagious period in all of HIV infection. (Great CROI 2012 presentation by Bernie here, when you have a moment.) The Western blot is barely more effective as a “confirmatory” test in this setting than if the sample had been sent for Tropheryma whipplei antibody - and we all know how often those are helpful. The case highlights what Bernie Branson from the CDC has been telling us for years, which is that the Western blot is lousy at detecting recently acquired HIV. The patient suspected something might be wrong with that advice (you think?) and sought a second opinion from one of my colleagues, who sent the viral load. Not only that, but the clinician who did the testing told him that he should return in 6 weeks for a repeat test to see if he fully seroconverts.
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