A 30 year old lady tested positive for HIV in 2011 during routine antenatal check up of her first pregnancy. The patient confirmed the same from multiple other laboratories as is the norm (most patients don't want to accept the lab results of their positivity). He CD4 was 864. She was on regular follow up and showed a gentle CD4 decline over time. Her last CD4 in June 2017 was 364 but she declined therapy, preferring to wait. Her Plasma HIV viral load done twice were in undetectable range.
She had a febrile episode in August 2017 and went a different hospital. The Doctor tested HIV again that was negative. the febrile episode was likely viral from which she recovered fully. She reported for reconfirmation of her HIV status. Her HIV testing is negative now, both HIV 1 and HIV 2. Her CD4 remains low while her plasma HIV viral load is not detectable. I am sending her samples for western blot testing.
Clinically, she does not have any opportunistic infections or any connective tissue disorders.
What might be the reason for a HIV test turning negative while her CD4 continues to decline. Could it be a hitherto undescribed retrovirus? Would appreciate any suggestions.
An elite controller would not explain the antibody turning negative
Though this study was on early ARV use, it may explain the seroreversion as being dependent in some measure on the ELISA test used. Also, she probably IS an elite controller if she is undetectable; progression often still occurs in this group.
https://www.ncbi.nlm.nih.gov/pubmed/16447118
and
https://www.ncbi.nlm.nih.gov/pubmed/27317797
If it were possible to look at more cell subsets in her case as well to look at patterns of expression on her B, CD4, CD8, NKs, maybe DCs....still, an unusual case if she had no early treatment. I'm curious what others think.
Dear Niklas Thilo,
In India, HIV positivity is declared if a person is positive by ELISA method using three different antigens. False positivity though possible is extremely unlikely. Immunoblot is only done in indeterminate cases, so it was not done in this case.
Like I mentioned earlier, this lady got her tests independently confirmed from a couple of other labs, but they too did only ELISAs.
HIV RNA was never positive in this lady, but then considering her CD4 were well above 800 initially, this did not surprise us.
Thank you
It is likely that the initial HIV tests were false positives....it would be good to check if there were any similar cases with other subjects with comparatively high CD4 counts (about 500/ml) tested from the same lab that eventually "turned" HIV negative. It would also be good to report on the limit of detection of the initial RNA tests (PCR) that were reported as "below limit of detection"......was limit 400c/ml, 50c/ml or less?
The scenarios in which HIV positive tests would turn negative (really false negative) would be very advanced AIDS- immune anergy- and possibly extreme protein energy malnutrition which do not seem to be the case in this subject
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