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Temporary seronegativity in a human immunodeficiency virus type 1-infected man
H L Zaaijer1, M H Bloemer, P N Lelie
1Clinical Microbiology and Infection Control, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
Journal of Medical Virology
|January 1, 1997
Summary
This case study highlights a patient with conflicting HIV test results and symptoms. It emphasizes considering HIV infection despite negative tests, especially with severe symptoms.
Area of Science:
- Infectious Diseases
- Immunology
- Clinical Virology
Background:
- Human Immunodeficiency Virus (HIV) infection diagnosis relies on serological testing, including antibody and antigen detection.
- Typical HIV seroconversion involves a window period followed by detectable antibodies and declining p24 antigen.
- Advanced HIV infection or Acquired Immunodeficiency Syndrome (AIDS) can sometimes impair antibody production.
Observation:
- A patient presented with a fluctuating pattern of anti-HIV screening results (positive-negative-positive) over three months.
- Clinical signs such as weight loss, esophageal candidiasis, and Pneumocystis carinii pneumonia indicated severe illness.
- CD4 cell counts were persistently low, and an IgM anti-HIV response was absent, suggesting late-stage disease.
Findings:
- Despite initial and evolving positive tests, the patient's clinical presentation suggested advanced HIV/AIDS.
- The Western blot pattern suggested recent infection, while severe symptoms pointed to late-stage disease.
- Diagnostic ambiguity persisted, making it difficult to differentiate between acute severe infection and advanced disease with impaired antibody response.
Implications:
- This case demonstrates that HIV serology can be atypical and may not always follow established patterns.
- Negative anti-HIV assay results should not exclude the possibility of HIV infection in patients with suggestive clinical signs.
- Clinicians must consider HIV infection in differential diagnoses, even with discordant or negative serological tests, particularly in individuals presenting with severe opportunistic infections or immunodeficiency.