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HIV infection found no antibody
Hello Doctor
Do you know of this study:
http://journals.lww.com/aidsonline/Fulltext/2010/06190/Seronegative_HIV_1_infection__a_review_of_the.2.aspx
1) Is this study seriously?
2) If you have tested those people with a 4th generation DUO-test (after 12 weeks), this would have to be HIV-positive (detected on the basis of p24 antigen)?
3) Why does it happen? Because of immune deficiencies? Because older test's?
thank you very much
Do you know of this study:
http://journals.lww.com/aidsonline/Fulltext/2010/06190/Seronegative_HIV_1_infection__a_review_of_the.2.aspx
1) Is this study seriously?
2) If you have tested those people with a 4th generation DUO-test (after 12 weeks), this would have to be HIV-positive (detected on the basis of p24 antigen)?
3) Why does it happen? Because of immune deficiencies? Because older test's?
thank you very much
MEDICAL PROFESSIONAL
Welcome to the forum, and thank you for bringing my attention (and perhaps Dr. Hook's) to this excellent article. I had not previously been aware of it. The authors are highly respected investigators, and the senior author, Dr. Joel Gallant, is an acquaintance of mine and I believe a close friend of Dr. Hook's.
The article should be reassuring to those worried about having false negative HIV tests, for several reasons.
* First, the authors could find only 25 reported cases worldwide in the 30+ years of the known HIV/AIDS epidemic. Given the millions and millions of known cases, almost all of whom had positive antibody tests, this is an exceedingly small number.
* Second, the results apply only to the stand-alone antibody tests. All the patients described had (or clearly would have had) positive DNA/RNA tests and p24 antigen tests.
* Third, none of the reported patients was asymptomatic. All or nearly all were quite ill; most had more aggressive clinical courses than the average HIV infected person, with quick progression to overt AIDS. So these results probably do not apply, or apply even more rarely, to exposed persons without symptoms.
* Fourth, the authors discuss only a single case of someone with a false-negative antibody test because the patient was taking a potent immunosuppressive drug (mycophenolic acid, used to prevent organ rejection in some transplant patients). (I previously have said that such cases are theoretical, with few if any actual reported cases. My belief is now confirmed, and in particular people need not worry if they are taking mild immunosuppressive medications, corticosteroid creams, etc.)
* Fifth, it appears that no false test results were related to other underlying illnesses. This forum gets many questions from people who worry that having had a cold, pneumonia, mononucleosis, or any number of other illnesses might have made their tests falsely negative. No such cases were found in this study.
To your specific questions:
1) It is a serious and well done review paper, published in a prestigious peer-reviewed journal. The results are valid, within the limits of any paper dependent on reviewing other published work.
2) As noted above, the results are pertinent only to the antibody-only tests (ELISA, etc). A negative duo (combo, or "4th generation") test remains 100% reliable 4 weeks or more after the last possible exposure.
3) The authors speculate about why false negative antibody tests may rarely occur, but were unable to think of a good reason. They speculate that it may be caused by an unusually rapid progression to high viral loads and overt AIDS; but they also speculate that the reverse may be true, that failure to produce effective antibody contributes to rapid progression. In any case, they found no evidence of any underlying cause. It appears to be random and very rare.
Thanks for the opportunity to comment. I'm going to save this thread so that others with concerns about false negative tests can be referred to it.
Regards-- HHH, MD
The article should be reassuring to those worried about having false negative HIV tests, for several reasons.
* First, the authors could find only 25 reported cases worldwide in the 30+ years of the known HIV/AIDS epidemic. Given the millions and millions of known cases, almost all of whom had positive antibody tests, this is an exceedingly small number.
* Second, the results apply only to the stand-alone antibody tests. All the patients described had (or clearly would have had) positive DNA/RNA tests and p24 antigen tests.
* Third, none of the reported patients was asymptomatic. All or nearly all were quite ill; most had more aggressive clinical courses than the average HIV infected person, with quick progression to overt AIDS. So these results probably do not apply, or apply even more rarely, to exposed persons without symptoms.
* Fourth, the authors discuss only a single case of someone with a false-negative antibody test because the patient was taking a potent immunosuppressive drug (mycophenolic acid, used to prevent organ rejection in some transplant patients). (I previously have said that such cases are theoretical, with few if any actual reported cases. My belief is now confirmed, and in particular people need not worry if they are taking mild immunosuppressive medications, corticosteroid creams, etc.)
* Fifth, it appears that no false test results were related to other underlying illnesses. This forum gets many questions from people who worry that having had a cold, pneumonia, mononucleosis, or any number of other illnesses might have made their tests falsely negative. No such cases were found in this study.
To your specific questions:
1) It is a serious and well done review paper, published in a prestigious peer-reviewed journal. The results are valid, within the limits of any paper dependent on reviewing other published work.
2) As noted above, the results are pertinent only to the antibody-only tests (ELISA, etc). A negative duo (combo, or "4th generation") test remains 100% reliable 4 weeks or more after the last possible exposure.
3) The authors speculate about why false negative antibody tests may rarely occur, but were unable to think of a good reason. They speculate that it may be caused by an unusually rapid progression to high viral loads and overt AIDS; but they also speculate that the reverse may be true, that failure to produce effective antibody contributes to rapid progression. In any case, they found no evidence of any underlying cause. It appears to be random and very rare.
Thanks for the opportunity to comment. I'm going to save this thread so that others with concerns about false negative tests can be referred to it.
Regards-- HHH, MD
MEDICAL PROFESSIONAL
Dr. Hook also reminds me that most of the 25 cases occurred before 2000. Testing techologies have improved since then and such cases probably are now even more rare than they were.
A related discussion, Window period was started.
This is reassuring indeed. When the CDC states that 97% of persons testing at 3 months would show as antibody positive (or negative), that 3% always leaves me with questions. My only even possible exposure was a person masturbating next to me then touching me in a steamroom once, and (on the same day) getting a massage where the male therapist masturbated himself but got a tiny amount of semen on me when he ejaculated (which he wiped off). I had a DNA HIV test at 7 weeks (negative), and several antibody tests out to 12 weeks, also negative. If this report is true, then I would think that the CDC estimates of a test at 12 weeks missing up to 3% of infections is also over conservative -- and that I can truly rely on my results and continue being with my regular partner (indeed, and conclusively, HIV negative). Thanks for sharing this report. It puts to rest any remaining, albeit irrational, fears.
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