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Antiretroviral therapy-induced negative HIV antibody test following diagnosis of HIV infection

2019; Lippincott Williams & Wilkins; Volume: 33; Issue: 11 Linguagem: Inglês

10.1097/qad.0000000000002261

1473-5571

Eduardo Shahar, Aaron Shapiro, Lylia Baskin, Zipi Kra Oz,

HIV/AIDS drug development and treatment

Best HIV treatment practices call for antiretroviral therapy (ART) initiation as soon as possible after diagnosis in order to limit the viral reservoir size and improve disease prognosis [1–3]. Diagnosis now relies on a fourth generation antigen/antibody immunoassay for HIV serology testing, which allows earlier viral infection identification than previously available [4,5]. Recently, we initiated ART in a 46-year-old woman, 3 weeks following acute HIV infection. This case narrative describes her test results over 34 weeks, during which two combination screening tests were used, Abbott ARCHITECT Combo Ab/Ag (Combo) and VIDAS HIV5 (Vidas), together with the GEENIUS confirmatory antibody test, viral load, and CD4+ cell level measurements. Combo assay was conducted first for initial diagnostic screening during hospitalization, yielding a positive value of 31.69. Additional results included a positive HIV RT-PCR; VIDAS Ag, 7.11; VIDAS ab test, ND; and viral load, greater than 10 000 000 copies/ml. ART was initiated. Repeated VIDAS, Combo, and GEENIUS tests all yielded repeated negative results 1 to 2 weeks after treatment initiation. Viral load declined sharply to 27 000 copies/ml, 2 weeks after treatment. Ten weeks after ART initiation, the Combo remained negative and the VIDAS yielded a low positive. Over subsequent weeks, repeat Combo and GEENIUS tests were slightly elevated, to borderline positive results with an undetectable viral load (Table 1). Twenty weeks after infection and 17 weeks after ART initiation, repeat Combo Architect and VIDAS tests elevated slightly to mild positive results, with no antibody value changes at 20 weeks (Table 1).Table 1: Overview of posttreatment test results.We postulate that the mechanism for lack of HIV antibodies in this patient is a consequence of reduced antigenic stimulus resulting from effective virologic control with ART. To date, a few reports of seroconversion failure after HIV therapy initiation exist, particularly in pediatric populations [6,7]. However, earlier diagnosis and treatment initiation make this scenario more feasible than before. This instance of a newly infected HIV patient whose treatment led to a failure in producing an adequate antibody response is an important observation. This phenomenon potentially leads to diagnostic uncertainty and confusion for the patient who may doubt the accuracy of their diagnosis. Clinicians and patients must understand that, despite a nonantibody response and negative HIV antibody tests, the infection is persistent and treatment should continue to prevent viral rebound after ART discontinuation. Acknowledgements Conflicts of interest There are no conflicts of interest.