False negative HIV-1 proviral DNA polymerase chain reaction in a patient with primary infection acquired in Thailand.
BACKGROUND
Qualitative HIV-1 proviral DNA PCR tests have three main diagnostic applications. These include direct detection of viral sequences in the pre-seroconversion window period which may be positive up to 8 days prior to the development of HIV specific antibodies; resolution of indeterminate HIV serological tests and in the diagnosis of neonates born to seropositive mothers where maternal antibodies may be detectable for up to 15 months past partum.


METHODS
A total of three serial specimens from a single patient following symptomatic primary HIV-1 infection were assessed by commercially available serological assays for antibodies to HIV and HIV-1 antigen and nucleic acid amplification assays for proviral DNA (Amplicor HIV-1 test, Roche Molecular Systems, CA, USA) and RNA (HIV MONITOR ver1.5, Roche Molecular Systems) according to manufacturers recommendations. A subsequent modified PCR protocol for HIV proviral DNA was performed which included modified primers (SK145/SKCC1B) and altered thermal cycling parameters.


RESULTS
We describe a case of HIV infection acquired in Thailand by heterosexual transmission, where a commercially available HIV proviral DNA PCR assay remained negative despite a typical evolving serological profile consistent with seroconversion.


CONCLUSIONS
These data support the use of HIV DNA PCR tests only as a second line supplemental test to licensed standard HIV diagnostic testing strategies, and should be used with care in cases where non-B subtype infection is a possibility.
Cunningham
Philip
P
NSW State Reference Laboratory for HIV/AIDS, Centre for Immunology, St Vincent's Hospital, Sydney, NSW 2010, Australia. p.cunningham@cfi.unsw.edu.au
Marriott
Deborah
D
Harris
Claire
C
Hancock
Sara
S
Carr
Andrew
A
Cooper
David
D
D015492:AIDS Serodiagnosis / Q000379:methods; D001483:Base Sequence; D017931:DNA Primers / Q000235:genetics; D004279:DNA, Viral / Q000097:blood / Q000235:genetics; D005188:False Negative Reactions; D015483:HIV Antibodies / Q000097:blood; D016655:HIV Core Protein p24 / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis* / Q000635:transmission / Q000821:virology; D006679:HIV Seropositivity / Q000175:diagnosis / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000235:genetics* / Q000302:isolation & purification*; D006801:Humans; D016133:Polymerase Chain Reaction / Q000379:methods*; D011533:Proviruses / Q000235:genetics / Q000302:isolation & purification; D013785:Thailand; D013997:Time Factors
D017931:DNA Primers; D004279:DNA, Viral; D015483:HIV Antibodies; D016655:HIV Core Protein p24