INTERPRETATION OF INDETERMINATE HIV SEROLOGY RESULTS IN AN INCARCERATED POPULATION

The objective of this study was to evaluate the significance of indete rminate HIV test results in the prison setting. No specific informatio n or guidelines are currently available to direct counseling of incarc erated persons with an indeterminate HIV test. A medical chart review was conducted on all incarcerated inmates at the Rhode Island State Pr ison who received indeterminate HIV test results between the inception of mandatory testing in 1990 and October 1996. Thirty-five inmates ha d an indeterminate HIV Western blot (WB) result, and 31 had follow-up HIV testing. Twenty-three of 31 (74%) of the prisoners with follow-up HIV tests seroconverted (95% confidence interval, 55%-88%). Drug/alcoh ol use, including crack cocaine and injection drug use, was strongly a ssociated with seroconversion (p < 0.01, odds ratio [OR] = 11.8, relat ive risk [RR] = 2.04). Injection drug use was also significantly assoc iated with seroconversion (p = 0.03, OR = 9.3, RR = 1.56). This is the highest rate of seroconversion ever reported for persons with indeter minate WB test results. Indeterminate test results need to be interpre ted differently in the prison setting than in the community. Prison in mates with indeterminate HIV serology should be counseled that in all likelihood they are HIV-infected, and confirmatory viral load testing should be conducted immediately.