title: A case of seronegative HIV-1 infection.
abstract: Patients infected with human immunodeficiency virus type 1 (HIV-1) typically seroconvert within weeks of primary infection. In rare cases, patients do not develop antibodies against HIV-1 despite demonstrable infection. We describe here a human leukocyte antigen (HLA)-B*5802-positive individual who presented with acquired immune deficiency syndrome despite repeatedly negative HIV-1 antibody screening test results. Phylogenetic analysis of env clones revealed little sequence diversity, and weak HIV-1-specific CD8(+) T cell responses were present to Gag epitopes. The patient seroconverted after immune reconstitution during receipt of highly active antiretroviral therapy. Lack of an antibody response to HIV-1 is rare and appears to be due to a defect in HIV-1-specific immunity rather than infection with attenuated virus.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. jblanks@jhmi.edu
authors.forename: Adam M
authors.initials: AM
authors.lastname: Spivak
authors.forename: Tim P
authors.initials: TP
authors.lastname: Brennan
authors.forename: Karen A
authors.initials: KA
authors.lastname: O'Connell
authors.forename: Emily
authors.initials: E
authors.lastname: Sydnor
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Williams
authors.forename: Robert F
authors.initials: RF
authors.lastname: Siliciano
authors.forename: Joel E
authors.initials: JE
authors.lastname: Gallant
authors.forename: Joel N
authors.initials: JN
authors.lastname: Blankson
mesh_terms: D001483:Base Sequence; D015686:Gene Products, env / Q000235:genetics; D015483:HIV Antibodies / Q000097:blood*; D015658:HIV Infections / Q000097:blood* / Q000276:immunology; D018023:HIV Seronegativity / Q000276:immunology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D015686:Gene Products, env; D015483:HIV Antibodies