HIV-1 Seronegativity in a Child With Proved Perinatal HIV Infection on HAART

The researchers conducted a case study to report the unexpected absence of HIV-1 antibodies and provirus in the peripheral blood of a four-year-old with previously diagnosed perinatal HIV infection. The study included a review of clinic and laboratory records and confirmation of results of HIV-1 enzyme linked immunosorbent assay (ELISA), western blot and HIV-1 DNA PCR from reference laboratory.

The investigators found that the child had "high plasma viral load at the initiation of highly active antiretroviral therapy (HAART) at 10 months of age. Following undetectable HIV viremia continuously for a 3-year period, he had normal CD4 and immunoglobulin levels. When retested at request of the parent, HIV-1, ELISA, western blot and HIV DNA PCR were all negative, raising the question of misdiagnosis and the parental misperception of a 'cure.' A rebound increase in viral load on cessation of therapy led to these diagnostic tests becoming positive again, with better parental acceptance of the diagnosis and treatment plan.

"Patients and providers should exercise caution in interpreting negative serological tests in children on HAART," the authors concluded.

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