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Mohamed H, Hedriana HD, Holbrook EA, Henderson H, Wilson JW. HIV False-Positive Test in the Setting of CD4 Lymphocytopenia. Cureus 2024; 16:e51515. [PMID: 38304642 PMCID: PMC10831196 DOI: 10.7759/cureus.51515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/03/2024] Open
Abstract
In 2016, we implemented a non-targeted Emergency Department (ED)-based HIV screening program at our academic medical center following revised CDC guidelines utilizing the Abbott Alinity 4th generation HIV-1/2 antigen (Ag)/antibody (Ab) immunoassay (Abbott Laboratories, Abbott Park, IL). Following the CDC algorithm, after reactive fourth-generation testing, HIV-1/2 Ab testing is conducted. Patients undergoing acute seroconversion (acutes) may express p24 Ag but have a negative confirmatory Ab test. Acutes have the same laboratory signature during the ED encounter as those that are false positive (False +), and the two patient groups are denoted as "equivocals" until viral load testing specifies a definitive HIV status. Among False + patients (Ab/Ag positive, Ab negative, viral load undetectable), there have been limited studies on those also demonstrating a reduction in CD4+ count, an uncommon phenomenon known as "idiopathic CD4 lymphocytopenia." We review a patient with a reactive fourth-generation HIV Ab/p24 Ag test on two separate occasions. Despite lymphopenia with a reduced CD4 count, his symptoms resolved, and an RNA PCR test did not detect any presence of HIV (False +). This patient was unique as False + patient with p24 Ag reactive, as well as a coincidental low CD4 count in the absence of HIV infection. A low CD4 count is often a sign of significant HIV infection.
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Affiliation(s)
| | | | | | - Heather Henderson
- Emergency Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Jason W Wilson
- Emergency Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
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2
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Balasubramanian A, Singh D, Lahey T. COVID-19 infection and a repeated false positivity effect in HIV testing: A case report. IDCases 2023; 34:e01908. [PMID: 37860150 PMCID: PMC10582350 DOI: 10.1016/j.idcr.2023.e01908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023] Open
Abstract
Several reports in the literature have described the association between SARS-CoV-2 infection and false positive HIV testing results. We present a case of a cisgender male who has sex with men with a false positive HIV test after fully recovering from COVID-19 14 days prior. Initial 4th generation HIV 1 and 2 antibody/antigen testing was positive twice, but confirmatory antibody testing was negative. HIV viral load was persistently undetectable. Most of the previously published case reports describe concurrent testing and positivity for HIV and COVID-19. Our report stands out due to the implication of a potentially prolonged association that could persist for several weeks.
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Affiliation(s)
| | - Devika Singh
- University of Vermont, Robert Larner College of Medicine, United States
| | - Timothy Lahey
- University of Vermont, Robert Larner College of Medicine, United States
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Elsner C, Appeltrath GA, Konik M, Parreuter J, Broecker-Preuss M, Krawczyk A, Esser S, Sammet S, Karsten CB. False-Positive Screening and Confirmatory HIV Diagnostic Test in a Patient with Cured SARS-CoV-2 Infection Is Not Mediated by Env/Spike Cross-Reactive Antibodies. Viruses 2023; 15:v15051161. [PMID: 37243248 DOI: 10.3390/v15051161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Acute SARS-CoV-2 infection has been associated with false-positive HIV screening tests. The underlying mechanism is unclear, and for clinical cases, evidence beyond a temporal connection is missing. However, several experimental studies point toward SARS-CoV-2 spike/HIV-1 envelope (Env) cross-reactive antibodies (Abs) as a cause. Here, we present the first case of an individual with convalescent SARS-CoV-2 infection testing false positive in both an HIV screening and confirmatory test. Longitudinal sampling showed that the phenomenon was temporary but lasted for at least 3 months before waning. After excluding a multitude of common determinants for assay interference, we further show by antibody depletion studies that SARS-CoV-2-spike-specific Abs did not cross-react with HIV-1 gp120 in the patient sample. No additional case of HIV test interference was identified in a cohort of 66 individuals who presented to a post-COVID-19 outpatient clinic. We conclude the SARS-CoV-2-associated HIV test interference to be a temporary process capable of disturbing both screening and confirmatory assays. The assay interference is short-lived and/or rare but should be considered by physicians as a possible explanation for unexpected HIV diagnostic results in patients with a recent SARS-CoV-2 infection.
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Affiliation(s)
- Carina Elsner
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Gwenllian A Appeltrath
- Institute for Translational HIV Research, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Margarethe Konik
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Janine Parreuter
- Institute for Translational HIV Research, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Martina Broecker-Preuss
- Laboratory Medicine Section, Department of Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, 44892 Bochum, Germany
| | - Adalbert Krawczyk
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Stefan Esser
- Institute for Translational HIV Research, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Clinic of Dermatology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Stefanie Sammet
- Clinic of Dermatology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Christina B Karsten
- Institute for Translational HIV Research, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
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Vega LE, Espinoza LR. Human immunodeficiency virus infection (HIV)-associated rheumatic manifestations in thepre- and post-HAART eras. Clin Rheumatol 2020; 39:2515-2522. [PMID: 32297034 PMCID: PMC7159285 DOI: 10.1007/s10067-020-05082-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022]
Abstract
Rheumatic manifestations remain an important clinical manifestation associated to HIV. To date after 4 decades of the onset of the HIV/AIDS pandemic, almost 37 million individuals are living with the infection, including close to 2 million of newly infected individuals. The status, however, of a considerable proportion of HIV/AIDS patients has changed from a near fatal disorder secondary to opportunistic infections to a chronic disease in which renal cardiovascular, diabetes, malignancy, and autoimmune co-morbid disorders have become prevalent and relevant. In addition, the spectrum of rheumatic disorders also has changed since the introduction of HAART and its diagnosis and treatment represents a challenge. The purpose of this review is to define and discuss the HIV-related rheumatic manifestations in the pre- and post-HAART eras.
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Affiliation(s)
- Luis E Vega
- Section of Rheumatology, Air Force Hospital, Aramburú Ave 2nd block, Lima, Peru.
| | - Luis R Espinoza
- Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA, 70112, USA
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Kocemba-Pilarczyk KA, Ostrowska B, Dudzik P, Markiewicz MJ, Sotirios Souza Pegos D, Lim C. Application of case study to introduce medical students to molecular biology techniques used in HIV diagnostics. BIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION : A BIMONTHLY PUBLICATION OF THE INTERNATIONAL UNION OF BIOCHEMISTRY AND MOLECULAR BIOLOGY 2019; 47:355-360. [PMID: 30835930 DOI: 10.1002/bmb.21232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/07/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Diagnostic molecular biology is a fast developing discipline of laboratory medicine widely used in numerous medical branches such as oncology, hematology, immunology, internal medicine, or infectious diseases, which will certainly have a major impact on clinical medicine in the near future. Nowadays, educational process is forced to face the quickly growing overflow of easily accessible data and properly guide the students not to be lead astray in the information chaos. Hence, in view of the foregoing, it appears obvious that modern medical education should put particular stress on selective acquiring, interpreting, and applying integrated multidisciplinary knowledge rather than on just absorbing and memorizing huge amount of scattered information. The presented case study aims at familiarizing the students with basic molecular biology techniques such as enzyme-linked immunosorbent assay, Western blot, and quantitative reverse transcription-polymerase chain reaction. Importantly, it is not limited only to discussing and learning the principles of the assays mentioned earlier, but it also shows their practical application in a particular diagnostic process and give the guidelines on how to explain and interpret exemplary results. In parallel, the way the case study is constructed allows a tutor to lead students into discussion on clinical aspects related to HIV infection what should eventually create complete picture of a HIV diagnostic process, thereby integrating basic knowledge of molecular biology laboratory techniques, HIV biology, and immunological response. © 2019 International Union of Biochemistry and Molecular Biology, 47(3):355-360, 2019.
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Affiliation(s)
| | - Barbara Ostrowska
- Chair of Medical Biochemistry, Jagiellonian University Medical College, Kraków, Poland
| | - Paulina Dudzik
- Chair of Medical Biochemistry, Jagiellonian University Medical College, Kraków, Poland
| | - Michał J Markiewicz
- Chair of Medical Biochemistry, Jagiellonian University Medical College, Kraków, Poland
| | | | - Chaewon Lim
- Chair of Medical Biochemistry, Jagiellonian University Medical College, Kraków, Poland
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Human Immunodeficiency Virus Infection: Spectrum of Rheumatic Manifestations. INFECTIONS AND THE RHEUMATIC DISEASES 2019. [PMCID: PMC7120519 DOI: 10.1007/978-3-030-23311-2_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Emerging and reemerging viral infections have been a characteristic feature of the past several decades, with HIV infection being the most important example of an emergent viral infection. To date, the status of a considerable proportion of HIV/AIDS patients has changed from a near-fatal disorder secondary to opportunistic infections to a chronic disease in which a variety of co-morbid conditions have become prevalent and relevant. Arthralgia and myalgias are the most common symptoms. The rate of spondyloarthritis varies according to the geographic area, genetic and mode of transmission. Most RA and SLE patients might go into remission after the development of AIDS, but also there are patients that continue with active disease. Prevalence of DILS is highest among African Americans in less advanced stages. PAN is clinically less aggressive and peripheral neuropathy is the most common clinical manifestation. Anti-phospholipid syndrome (APS), systemic sclerosis and poly-dermatomyositis are uncommon. After the introduction of combination antiretroviral therapy (cART), a decline of spondyloarthritis disorders and of DILS and development of new syndromes such as IRIS, osteoporosis and avascular bone necrosis have occurred. The treatment of patients with rheumatic diseases and HIV infection remains a challenge.
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Rattanathammethee K, Chawansuntati K, Chaiwarith R, Praparattanapan J, Supparatpinyo K, Wipasa J. Dot enzyme-linked immunosorbent assay strip as a screening tool for detection of autoantibody to interferon gamma in sera of suspected cases of adult-onset immunodeficiency. J Clin Lab Anal 2018; 32:e22460. [PMID: 29682788 DOI: 10.1002/jcla.22460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/02/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Being able to detect the presence of autoantibodies to interferon (IFN)-γ in serum is essential for evaluating patients with suspected adult-onset immunodeficiency (AOID) with unusual intracellular infections. Most reported patients with AOID have been Asian, although the exact prevalence of this illness is unknown. To date, no standard assay exists to detect autoantibodies to IFN-γ. An easy-to-use, low-cost assay that can be performed in any laboratory would be a valuable tool for clinical management of AOID, as well as better reveal its prevalence. METHODS Our experimental study exploited a dot enzyme-linked immunosorbent assay (Dot-ELISA) strip to detect autoantibodies to IFN-γ. Sera from 66 HIV-negative patients having autoantibodies to IFN-γ as determined by indirect ELISA were tested. RESULTS Dot enzyme-linked immunosorbent assay was sensitive (100%) and specific (94.5%), with a positive predictive value of 97.6% and a negative predictive value of 100%. CONCLUSION This simple method provides prompt qualitative results that can be read visually and used in facilities with limited testing capabilities.
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Affiliation(s)
| | | | - Romanee Chaiwarith
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jutarat Praparattanapan
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Khuanchai Supparatpinyo
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jiraprapa Wipasa
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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HIV infection and its effects on the development of autoimmune disorders. Pharmacol Res 2018; 129:1-9. [DOI: 10.1016/j.phrs.2018.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 12/28/2017] [Accepted: 01/09/2018] [Indexed: 01/05/2023]
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Adizie T, Moots RJ, Hodkinson B, French N, Adebajo AO. Inflammatory arthritis in HIV positive patients: A practical guide. BMC Infect Dis 2016; 16:100. [PMID: 26932524 PMCID: PMC4774153 DOI: 10.1186/s12879-016-1389-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 01/27/2016] [Indexed: 12/01/2022] Open
Abstract
Background Musculoskeletal manifestations of the human immunodeficiency virus (HIV) have been described since the outset of the global HIV epidemic. Articular syndromes that have been described in association with HIV include HIV-associated arthropathy, seronegative spondyloarthropathies (SPA) (reactive arthritis, psoriatic arthritis (PsA) and undifferentiated SPA), rheumatoid arthritis (RA) and painful articular syndrome. Methods We carried out a computer-assisted search of PubMed for the medical literature from January 1981 to January 2015 using the keywords HIV, acquired immune-deficiency syndrome, rheumatic manifestations, arthritis, spondyloarthropathy, anti-TNF and disease modifying antirheumatic drugs. Only English language literature was included and only studies involving adult human subjects were assessed. Results There are challenges in the management of inflammatory arthritis in patients who are HIV-positive, including difficulties in the assessment of disease activity and limited information on the safety of immunosuppressive drugs in these individuals. Conclusions This review focuses on the clinical characteristics of the inflammatory articular syndromes that have been described in association with HIV infection and discusses the therapeutic options for these patients.
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Affiliation(s)
- T Adizie
- Rheumatology Department, Heart of England NHS Trust, Birmingham, UK.
| | - R J Moots
- Rheumatology Department, Aintree University Hospital, Liverpool, UK. .,Clinical Sciences Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK.
| | - B Hodkinson
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
| | - N French
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection & Global Health, The University of Liverpool, Liverpool, UK.
| | - A O Adebajo
- Academic Rheumatology Group, Faculty of Medicine, University of Sheffield, Sheffield, UK.
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Cunha BM, Mota LMH, Pileggi GS, Safe IP, Lacerda MVG. HIV/AIDS and rheumatoid arthritis. Autoimmun Rev 2015; 14:396-400. [PMID: 25578483 DOI: 10.1016/j.autrev.2015.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/01/2015] [Indexed: 12/24/2022]
Abstract
The acquired immunodeficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). It was first recognized in the United States in 1981, and the HIV/AIDS epidemic has since spread to affect all countries. The interface of HIV/AIDS with opportunistic infectious diseases is well characterized, but further research is required into the concurrence of other chronic diseases. The objective of this review was to identify possible interferences of HIV infection in the diagnosis and management of rheumatoid arthritis (RA). A review of the available evidence was conducted using the GRADE approach. Overall, the quality of evidence was low. Our main conclusions were: (1) the occurrence of rheumatoid-like arthritis in patients with HIV/AIDS is quite rare; therefore, it is not recommended that HIV infection be considered routinely as a differential diagnosis in this condition (C2); (2) HIV infection may lead to rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody positivity, but usually at low titers (C1); (3) RA might cause false-positive HIV serology and ELISA seems to be a more specific test for HIV in patients with RA (C2); (4) RA and AIDS may coexist, even in cases of severe immunosuppression (C1); (5) RA emergence may seldom occur during or after immune reconstitution (C1); and (6) there is insufficient safety data to recommend use of specific disease-modifying antirheumatic drugs (DMARDs) in RA patients with HIV/AIDS. Therefore, these drugs should be used cautiously (C1).
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Affiliation(s)
| | | | - Gecilmara S Pileggi
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Izabella P Safe
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
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