Persistently negative HIV-1 antibody enzyme immunoassay screening results for patients with HIV-1 infection and AIDS: serologic, clinical, and virologic results. Seronegative AIDS Clinical Study Group.
OBJECTIVE
To describe persons with HIV infection and AIDS but with persistently negative HIV antibody enzyme immunoassay (EIA) results.


METHODS
Surveillance for persons meeting a case definition for HIV-1-seronegative AIDS.


METHODS
United States and Canada.


METHODS
A total of eight patients with seronegative AIDS identified from July 1995 through September 1997.


METHODS
Clinical history of HIV disease, history of HIV test results, and CD4 cell counts from medical record review; results of testing with a panel of EIA for antibodies to HIV-1, and HIV-1 p24 antigen; and viral subtype.


RESULTS
Negative HIV EIA results occurred at CD4 cell counts of 0-230 x 10(6)/l, and at HIV RNA concentrations of 105,000-7,943,000 copies/ml. Using a panel of HIV EIA on sera from three patients, none of the HIV EIA detected infection with HIV-1, and signal-to-cut-off ratios were < or = 0.8 or all test kits evaluated. Sera from five patients showed weak reactivity in some HIV EIA, but were non-reactive in other HIV EIA. All patients were infected with HIV-1 subtype B.


CONCLUSIONS
Rarely, results of EIA tests for antibodies to HIV-1 may be persistently negative in some HIV-1 subtype B-infected persons with AIDS. Physicians treating patients with illnesses or CD4 cell counts suggestive of HIV infection, but for whom results of HIV EIA are negative, should consider p24 antigen, nucleic acid amplification, or viral culture testing to document the presence of HIV.
Sullivan
P S
PS
Surveillance Branch, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Schable
C
C
Koch
W
W
Do
A N
AN
Spira
T
T
Lansky
A
A
Ellenberger
D
D
Lal
R B
RB
Hyer
C
C
Davis
R
R
Marx
M
M
Paul
S
S
Kent
J
J
Armor
R
R
McFarland
J
J
Lafontaine
J
J
Mottice
S
S
Cassol
S A
SA
Michael
N
N
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000276:immunology / Q000821:virology; D000293:Adolescent; D000328:Adult; D005188:False Negative Reactions; D005260:Female; D015483:HIV Antibodies / Q000276:immunology*; D015658:HIV Infections / Q000097:blood / Q000276:immunology* / Q000821:virology*; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male
D015483:HIV Antibodies