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:
Sore throat (lasted 2 days)
itchy rash under both armpits (lasted 3 weeks).
fatique (1 day).
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:
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.
swollen elbows. My doc said they were normal.
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:
can you comment on the article?
what are the HIV strains in Asia?
Can ELISA or PCR tests in USA detect Asian strains?
Should I get tested again at 12th month?
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.
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.
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.
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.