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Non-Clade B HIV-1 Infection
May 26, 2003

My concern is about test sensitivity and specificity for Non-Clade B HIV-1 Infection. I read an article In MedScape by Maria Ristig, MD; Pablo Tebas, MD stating that HIV-1 serology can be falsely negative in some cases of infection with non-B HIV (attached at the bottom)

My possible expsoure was around 6/27/02, vaginal sex with a message parlor girl from Asia. No condom, we used latex glove instead (penis inside one the glove finger). Blood was found on the "condom" after I pulled it out. She explained she was having her period.

2 months later after exposure, had a very bad cold that lasted over 3 weeks, symptoms:

1. Sore throat (lasted 2 days)

2. itchy rash under both armpits (lasted 3 weeks). 3. fatique (1 day).

4. Nasal congestion

I still have persistent symptoms (confirmed by doctor):

Nasal congestion: it's been 8 months. Saw ENT docs, did a surgery, not helpful. swollen cheek (left side), dry mouth Muscle twitching in plam, arms and legs

symptoms dismissed by doctor:

1) Muscle pain in the arms: it is strange that I feel pain when I try to turn on a light switch, but I don't feel that kind of pain when I lift heavy stuff, for example holding my 28 lbs baby in my arms.

2) swollen elbows. My doc said they were normal.

3) swollen glands under my jaw, both sides, like a peanut.

Test negative (Elisa) at 5th and 6th month, PCR RNA (first generation) at 6th month also neg.

I can't not accept the results because of

a) these persistent symptoms and

b) The sex worker is from Asia, the HIV subtypes (A, C, E?) are non-B.

My queston to you are:

1) can you comment on the article? 2) what are the HIV strains in Asia? 3) Can ELISA or PCR tests in USA detect Asian strains?

4) Should I get tested again at 12th month?

thanks Eric

attached ***************

http://www.medscape.com/viewarticle/441859

Management of a Patient With Non-Clade B HIV-1 Infection

from Medscape HIV/AIDS Posted 10/04/2002

Maria Ristig, MD; Pablo Tebas, MD

HIV-1 serology can be falsely negative in some cases of infection with non-B HIV subtypes or HIV-2.[13,14]

HIV-1 group M subtype B is the most prevalent within the United States, and available serologic tests are designed for this specific strain. In the case of groups O and N, the EIA can be false-negative, but the Western blot may be positive. In the case of HIV-2, which is more prevalent in western Africa, the EIA for HIV-1 can be false-negative in up to 30 of patients, while Western blot is weakly cross-reactive.

The current HIV test used in the United States is a combination HIV-1/HIV-2 enzyme immunoassay test kit that is sensitive to antibodies to both HIV-1 and HIV-2. The Centers for Disease Control and Prevention offer special serologic tests and viral sequencing for HIV-2 and for HIV-1 non-B subtypes.

ref.

13. Simon F, Mauclere P, Roques P, et al. Identification of a new human immunodeficiency virus type 1 distinct from group M and group O. Nat Med. 1998;4:1032-1037.

14. Schable C, Zekeng L, Pau CP, et al. Sensitivity of United States HIV antibody tests for detection of HIV-1 group O infections. Lancet. 1994;344:1333-1334.

Response from Mr. Kull

HIV is broken down into two major types: HIV-1 and HIV-2. HIV-1 can be broken down into three major groups: M, N, and O. The M group contains many different subtypes or clades (there are 11, A-K). Clades B, C, and E are within the M group; antibody tests are accurate for all subtypes within the M group (the group responsible for the vast majority, 99%, of infections in the world). Antibody testing is not as reliable for groups N and O, which are rare.

RMK



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