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HIV-1 seronegativity in a child with proved perinatal HIV infection on HAART
  1. N Desai,
  2. M Mathur,
  3. K Abu-Lawi
  1. Department of Pediatrics and Pathology, Kings County Hospital Center and SUNY Downstate Medical Center, Brooklyn, NY, USA
  1. Correspondence to:
 Ninad Desai
 MD, Kings County Hospital, B 6202, 451 Clarkson Avenue, Brooklyn, NY 11203, USA; desainnychhc.org

Abstract

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.

  • 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
  • perinatal HIV
  • HAART
  • seronegativity
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Footnotes

  • There are no financial disclosures or conflicts of interest applicable.

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