title: Misdiagnosis of HIV infection by HIV-1 plasma viral load testing: a case series.
abstract: BACKGROUND
  The availability of sensitive assays for plasma HIV viral load and the trend toward earlier and more aggressive treatment of HIV infection has led to the inappropriate use of these assays as primary tools for the diagnosis of acute HIV infection.
  
  
  OBJECTIVE
  To describe limitations in the use of plasma viral load testing for the diagnosis of HIV infection.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Academic medical centers in Providence, Rhode Island, and Worcester, Massachusetts.
  
  
  METHODS
  Three persons in whom HIV infection was falsely diagnosed by plasma viral load testing.
  
  
  METHODS
  Laboratory measures and clinical outcomes.
  
  
  RESULTS
  Two cases of false-positive results obtained by using branched-chain DNA plasma viral load assays and one case of a false-positive result obtained by using reverse transcriptase-polymerase chain reaction plasma viral load assay are reported. All three plasma viral load tests yielded positive results with low values (1254 copies/mL, 1574 copies/mL, and 1300 copies/mL). Infection with HIV was initially diagnosed in all three patients, but each patient subsequently tested negative by HIV-1 enzyme-linked immunosorbent assay and repeated plasma viral load testing.
  
  
  CONCLUSIONS
  Physicians should exercise caution when using plasma viral load assays to detect primary HIV infection, particularly when the pretest probability of infection is low.
authors.affiliation: Brown University School of Medicine, Providence, Rhode Island 02906, USA. josiahvrich@Brown.edu
authors.forename: J D
authors.initials: JD
authors.lastname: Rich
authors.forename: N A
authors.initials: NA
authors.lastname: Merriman
authors.forename: E
authors.initials: E
authors.lastname: Mylonakis
authors.forename: T C
authors.initials: TC
authors.lastname: Greenough
authors.forename: T P
authors.initials: TP
authors.lastname: Flanigan
authors.forename: B J
authors.initials: BJ
authors.lastname: Mady
authors.forename: C C
authors.initials: CC
authors.lastname: Carpenter
mesh_terms: D000328:Adult; D016516:CD4-CD8 Ratio; D002648:Child; D002985:Clinical Protocols; D004279:DNA, Viral / Q000097:blood; D003951:Diagnostic Errors; D004797:Enzyme-Linked Immunosorbent Assay; D005189:False Positive Reactions; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D019562:Viral Load
chemical_list: D004279:DNA, Viral