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Negative ELISA and PCR, But Still Infected?

Jul 31, 1998

Dear Doctor: From reading questions in this forum, it is clear that many readers, myself included, are struggling to accept negative HIV tests (often dozens of HIV tests) following an exposure. I've seen questions on "type O," "recombinant" strains, and so on. My question is whether, putting theory aside, you have you ever actually seen or heard of a patient(s) in the U.S. who was repeatedly ELISA AND PCR negative one year or more following an exposure and who turned out to actually be infected with HIV (despite EXTENSIVE research, I have found no such case). If so, how was the infection(s)confirmed? I have read about the two documented cases of Type O in the U.S. and I understand that the Maryland patient was pos by both ELISA and WB while the California patient at least had a pos ELISA most of the time. I have also read about "CD4 Depletion Syndrome" which, from what I've read, does not appear to be related to any particular pathogen. I guess I am just trying to give myself the reassurance that would come with knowing that, if, after a year of repeated neg. ELISAs and PCRs (both DNA and viral load), I was actually infected, I would make the medical journals. Thanks.

Response from Dr. Holodniy

I don't want anyone to make the medical journals for such a case, unless it is instructive for us in some way. The cases I described were seronegative (HIV ELISA and/or Western blot negative) and not PCR negative. I have never seen, read or heard of a case in which serology and PCR or other viral load/culture based assays were all negative and the person was found to be HIV-1 positive in some other way. MH

Mixed Strains
Recombinant HIV

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