HIV seronegativity in persons with AIDS - TheBody.com's Bulletin Boards

http://www.aegis.com/pubs/aidsline/1998/dec/m98c1584.html
"...:clinical and laboratory results from 8 cases, North America, 1995-1997.
Sullivan P,Koch W,Do AN etc;Centers for Disease Control/Prevention, Atlanta,GA,USA
Abstract: Background: Diagnosis of HIV infection and screening of blood donations are based on results of HIV EIA. False negative results in HIV EIA may delay diagnosis and therapy or compromise screening of blood donations. We sought to identify and describe clinical and laboratory testing histories of persons who had AIDS, but who had consistently negative HIV EIA.
Methods: We conducted active and passive surveillance with case investigation for persons who met the case definition for seronegative AIDS (HIV infection [proven by PCR testing], at least one AIDS-defining clinical condition, at least two negative HIV EIA during clinical care). We reviewed medical records, interviewed patients, tested sera from patients with 8 HIV EIAs licennsed in the US, and determined viral subtype by PCR.
Results: We identified 8 patients with seronegative AIDS from July 1995 through Sept. 1997.According to medical record reviews, patients had 3-39 negative HIV-EIA (median 6.5), which occurred at CD4 counts of 0-415 cells/microliter (median 63), and at HIV-RNA concentrations of 199,000 to 7,943,000 copies/mi. For sera from 3 patients, no HIV EIA detected infection with HIV, and signal-to-cutoff (s/c) ratios were <0.8 for all test kits evaluated. For sera from 5 other patients, HIV infection was detected by 2/8 (1 patient), 3/8 (3 patients) or 4/8 (1 patient) HIV EIA evaluated, although usually with s/c ratios between 1.0 and 2.0. All patients were infected with subtype B HIV-1 viruses. Three patients reported blood donation; loockback investigations for recipients of the donations are under way.
Conclusions: Results of HIV EIA may be consistently negative for some HIV infected persons outside the seroconversion window period, with subtype B strains, and over a broad range of CD4 counts. Physicians treating patients with illnesses or CD4 counts suggestive of HIV infection, but for whom results of HIV-EIA are negative, should consider HIV-1 p24 antigen testing, PCR, or viral culture.Continued population-based surveillance for HIV-EIA failures is important to identify possible emerging problems with HIV screening tests.
This information is designed to support, not replace, the relationship that exists between patients and doctors."

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