HIV
HIV-1 seronegativity in a child with proved perinatal HIV infection on HAART
Department of Pediatrics and Pathology, Kings County Hospital Center and SUNY Downstate Medical Center, Brooklyn, NY, USA
Correspondence to:
Correspondence to:
Ninad Desai
MD, Kings County Hospital, B 6202, 451 Clarkson Avenue, Brooklyn, NY 11203, USA; desain{at}nychhc.org
Objectives: To report the unexpected absence of HIV-1 antibodies and provirus in the peripheral blood of a 4 year old with previously diagnosed perinatal HIV infection.
Methods: Case study including review of clinic and laboratory records and confirmation of results of HIV-1 enzyme linked immunosorbent assay (ELISA), western blot, and HIV-1 DNA PCR from reference laboratory.
Results: This child had high plasma viral load at the initiation of highly active antiretroviral therapy (HAART) at 10 months of age. Following undetectable HIV viraemia continuously for a 3 year period, he had normal CD4 and immunoglobulin levels. When retested at the request of the parent, HIV-1 ELISA, western blot, and HIV DNA PCR were all negative, raising the question of misdiagnosis and the parental misperception of a "cure." A rebound increase in viral load on cessation of therapy led to these diagnostic tests becoming positive again, with better parental acceptance of the diagnosis and treatment plan.
Conclusions: Patients and providers should exercise caution in interpreting negative serological tests in children on HAART.
Abbreviations: ELISA, enzyme linked immunosorbent assay; Ext PC, external low positive control; HAART, highly active antiretroviral therapy; HPC, high positive control; NC, negative control; OD, optical density; PC, positive control; PCR, polymerase chain reaction; VL, viral load; WB, western blot; WPC, weak positive control
Keywords: perinatal HIV; HAART; seronegativity
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