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Seronegative HIV Infection

Summary and Comment |
November 23, 2009

Seronegative HIV Infection

  1. Sonia Nagy Chimienti, MD

A case report serves as a reminder that such infection does occur, sometimes with fatal consequences.

  1. Sonia Nagy Chimienti, MD

Seronegative HIV infection has been described previously but is quite unusual. In this brief report from Portugal, investigators described the phylogenetic analysis of a virulent HIV strain that resulted in a patient's rapid progression to AIDS and death.

The patient was a previously healthy 20-year-old heterosexual man who presented with fatigue and weight loss. Testing for infectious diseases, including serologic assays to detect antibodies to HIV-1 and HIV-2, provided no answers. Within 3 months, the patient developed oropharyngeal candidiasis, and his CD4 count dropped to 232 cells/mm3. HIV serology continued to be negative, even when his CD4 count dropped further, to 52 cells/mm3. Serum p24 antigen levels and plasma viral load were consistent with HIV infection. Within 6 months of his original presentation, he died of AIDS.

Immediately before symptom onset, the patient had a 3-month relationship with a woman who was a sex worker and injection-drug user. She, too, experienced an aggressive course of disease, presenting with a CD4 count of 40 cells/mm3 and succumbing to AIDS within 21 months. In her case, serologic testing did reveal HIV infection.

Phylogenetic testing confirmed that both patients were infected with a B/G recombinant variant that resembled a strain previously detected among injection-drug users in Spain and Portugal. Based on the presence of a heterogeneous virus population in the woman and a single virus population (all CCR5-tropic) in the man, researchers determined that transmission occurred from the woman to the man.

Comment

This case report serves as a reminder that when patients with symptoms of HIV infection have negative results on antibody tests, we should pursue additional virus-specific tests (such as viral load). HIV-infected individuals can be seronegative for a number of reasons, including seroreversion, late seroconversion, evaluation during the window period, and defects in the immune system that prevent development of a humoral response to infection. Also notable in this report is the finding that a genetically uniform population of CCR5-tropic variants can cause rapidly progressive, fatal HIV infection, a course generally thought to be associated with CXCR4-expressing variants.

Citation(s):

Reader Comments (4)

Muzafar Ahmed Naik

Its really interesting and reminds that laboratories should not mastermind clinicians rather clinicians should mastermind the labs.

Competing interests: None declared

Kewal Krishen Thassu

It is a very intresting case.In countries like India and other developing countries where O.P.D. Pt load is very high , Doctors may miss the diagnosis if serological test is found negative.

In cases where symptoms and signs stongly indicate the diagnosis and there is history of exposure ,Doctors must keep such cases in mind and go in for other teste like CD 4 count, Serum P24 antigen level and plasma viral load ,so that such cases are diagnosed in time and proper treatment started.

Competing interests: None declared

Daniela Gavrailova Nikolova

It is very interesting case from law-point of view to switch on antiretroviral therapy in such a patient.

Competing interests: None declared

Dr. Saka Venkat Satya Prasad

Its interesting to note that that HIV status as positive or negative is taking a new turn.It has also been noticed in a few govt hospitals that patients deteriorate rapidly and die early without a conclusive proof of underlying disease process.Testing kits are basically of Elisa which may or may not detect Status of HIV.Much needs to be probed into the seronegative HIV infections to save the vulnerable and innocent public.

Competing interests: None declared

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