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Resolution of a False-Positive Fourth-Generation HIV Screening Test by Polyethylene Glycol Precipitation: A Case
Mel-Marie Datka1, Whitney Fuller1, Hennessy Williams2
1Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA.
Insights
Fourth generation human immunodeficiency virus (HIV) antigen/antibody assays offer early detection but can yield false positives. Polyethylene glycol (PEG) precipitation resolved a discordant HIV test, suggesting PEG-precipitable immune interference caused the false reactivity.
Area of Science:
- Clinical diagnostics
- Immunology
- Virology
Background:
- Fourth-generation human immunodeficiency virus (HIV) antigen/antibody (Ag/Ab) assays provide sensitive early HIV detection.
- Rare instances of false-positive results can occur due to immunoassay interference.
Abstract:
Fourth generation human immunodeficiency virus (HIV) antigen/antibody (Ag/Ab) combination assays are highly sensitive and enable early detection of HIV infection; however, rare false positive results due to immunoassay interference may occur. We report a case of discordant HIV testing characterized by a reactive ARCHITECT HIV Ag/Ab Combo screening assay with negative HIV 1/HIV 2 antibody differentiation and negative HIV 1/HIV 2 qualitative nucleic acid testing. To investigate the mechanism of reactivity, polyethylene glycol (PEG6000) precipitation was performed. Following PEG treatment, the patient's specimen converted to non reactive on repeat screening; comparatively, a confirmed HIV positive control specimen remained strongly reactive, despite partial signal reduction. These findings support the presence of PEG-precipitable immune interference as a likely contributor to false reactivity and highlight PEG precipitation as a useful problem solving tool in selected cases of discordant HIV serologic results.
