title: Genomic DNA "finger-printing" in diagnostic virology to clarify discrepant HIV results.
abstract: BACKGROUND
  We describe two case studies in the antenatal setting where human immunodeficiency virus (HIV) antibody results were discrepant in serial sera. Root cause analysis including genomic DNA fingerprinting was performed.
  
  
  OBJECTIVE
  To analyze serial sera with HIV antibody discrepant results using genomic DNA "finger-printing" to determine whether the sera were from the same or different individuals.
  
  
  METHODS
  In case study 1, two serial sera with HIV antibody discrepant results, supposedly from a pregnant lady were subjected to root cause analysis. In case study 2, four serial sera 'from' a pregnant lady were subjected to root cause analysis. All sera were analyzed forensically using genomic DNA (gDNA) fingerprinting. In the case study 1, public health look-back exercise was done prior to forensic analysis unlike case study 2, when it was planned for later.
  
  
  RESULTS
  Case study 1 gDNA results showed that both sera had identical genotypes and sex indicating that these were from the same individual and that the problem was within automated serum separator pipette syringe. Case study 2 gDNA analysis showed that the 3 of 4 sera were from three different unrelated females indicating an intentional sample mix-up.
  
  
  CONCLUSIONS
  Forensic gDNA "finger-printing" in diagnostic virology changed the direction of the investigations; one pointing to a laboratory issue and the other to an intentional deception by the patient. We recommend considering gDNA fingerprinting in any sample discrepancy investigation prior to any public health investigation. This is the first reported use of gDNA analysis in diagnostic virology.
authors.affiliation: Consultant Virologist, South London Specialist Virology Center, King's College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom. Electronic address: msudhanva@nhs.net.
authors.forename: Malur
authors.initials: M
authors.lastname: Sudhanva
authors.affiliation: Viapath at King's College Hospital, Department of Molecular Pathology, King's College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom.
authors.forename: Tania
authors.initials: T
authors.lastname: Senior-McKenzie
authors.affiliation: Consultant Physician, Genitourinary Medicine, Medway Maritime Hospital NHS Foundation Trust, Gillingham, Kent ME7 5NY, United Kingdom.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Hembrom
authors.affiliation: Viapath at King's College Hospital, Department of Molecular Pathology, King's College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom.
authors.forename: Barnaby
authors.initials: B
authors.lastname: Clark
mesh_terms: D000328:Adult; D004247:DNA / Q000032:analysis; D016172:DNA Fingerprinting / Q000379:methods*; D003951:Diagnostic Errors; D005260:Female; D006678:HIV / Q000276:immunology; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000379:methods* / Q000592:standards; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012680:Sensitivity and Specificity
chemical_list: D015483:HIV Antibodies; D004247:DNA
keywords: AmpFlSTR; Discrepant HIV; Fingerprinting; Forensic; Genomic DNA; Pregnant