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Sriram R, Mahendradas P, Hande P, Patil A, Kawali A, Mishra SB, Rizvi S, Shetty R. Seroreversion in HIV-Associated Bilateral CMV Retinitis: A Challenging Case Report. Ocul Immunol Inflamm 2024:1-5. [PMID: 39120632 DOI: 10.1080/09273948.2024.2385606] [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: 02/28/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE To report a case of seroreversion in a patient with HIV-associated bilateral CMV retinitis and the challenges associated with detection of this phenomenon in late stages of HIV. METHOD Retrospective single case report. RESULTS The clinical picture of the patient on presentation was suggestive of viral retinitis. PCR confirmed a diagnosis of CMV retinitis. Serology for HIV-1 & 2 was negative. A viral load of HIV and CD-4 count confirmed his sero status to be positive for HIV. Improvement in visual acuity and slow resolution of the lesion was noted with both anti-viral for CMV and HIV. A repeat HIV-1 testing was positive with an improvement in CD4 count. CONCLUSION In highly suspicious individual, with a negative serology (post screening test) for HIV, the disease status should be confirmed by testing the individual for HIV viral load and CD4 count.
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Affiliation(s)
- Radhika Sriram
- Department of Uveitis and Ocular Immunology Services, Narayana Nethralaya, Bangalore, India
| | | | - Prathiba Hande
- Department of Vitreo-Retina Services, Narayana Nethralaya, Bangalore, India
| | - Aditya Patil
- Department of Uveitis and Ocular Immunology Services, Narayana Nethralaya, Bangalore, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology Services, Narayana Nethralaya, Bangalore, India
| | - Sai Bhakti Mishra
- Department of Uveitis and Ocular Immunology Services, Narayana Nethralaya, Bangalore, India
| | - Sara Rizvi
- Department of Uveitis and Ocular Immunology Services, Narayana Nethralaya, Bangalore, India
| | - Rohit Shetty
- Department of Cornea and Refractive Services, Narayana Nethralaya, Bangalore, India
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Stoffels K, Vanroye F, Mortier V, Debaisieux L, Delforge ML, Depypere M, Dessilly G, Vaira D, Vancutsem E, Van den Wijngaert S, Van Laethem K, Vercauteren KOA, Verhofstede C, Fransen K. Chronic and Early Antiretroviral Therapy Impact Human Immunodeficiency Virus (HIV) Serological Assay Sensitivity, Leading to More False-Negative Test Results in HIV Diagnosis. J Infect Dis 2021; 222:1660-1669. [PMID: 32433757 DOI: 10.1093/infdis/jiaa271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/15/2020] [Indexed: 11/14/2022] Open
Abstract
This retrospective study evaluated the reactivity of 3 human immunodeficiency virus (HIV) confirmatory assays (INNO-LIA, Geenius, and MP) and 7 HIV rapid tests on samples from 2 different study populations in Belgium. For the early-treated cohort (83 HIV-1 adult patients treated within 3 months after infection), HIV-1 diagnosis was not obtained in at least 1 confirmatory assay in 12.0% (10/83) and in an HIV rapid test in 31.3% (26/83). Confirmation assay sensitivities ranged from 87.5% to 95.2%, whereas rapid test assay sensitivities ranged from 75.9% to 100%. The time to treatment initiation or the length of time on treatment did not have a statistical influence on the probability to obtain a false-negative test result. The fastest reversion was demonstrated after 4 months of treatment. Among the long-term treated cohort (390 HIV-1 patients with ≥ 9 years of undetectable viral load), false-negative test results were found in at least 1 HIV confirmatory assay for 2.1% (8/390) of the patients and in a HIV rapid test for 4.9% (19/390). Confirmation assay sensitivities ranged from 98.1% to 99.5%, whereas rapid test sensitivities ranged from 96.2% to 100%. Longer treatment increased nonreactivity of the HIV rapid tests (P = .033). Undetectable viral load decreases the sensitivities of HIV diagnostic tests, and further monitoring of the performance of serological assays is advised.
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Affiliation(s)
- Karolien Stoffels
- AIDS Reference Laboratory, Centre Hospitalier Universitaire St Pierre, Brussels, Belgium
| | - Fien Vanroye
- HIV/STD Reference Laboratory, Clinical Virology Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Virginie Mortier
- AIDS Reference Laboratory, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Laurent Debaisieux
- AIDS Reference Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Melissa Depypere
- AIDS Reference Laboratory, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Géraldine Dessilly
- AIDS Reference Laboratory, Medical Microbiology Unit, Université Catholique de Louvain, Brussels, Belgium
| | - Dolores Vaira
- AIDS Reference Laboratory, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Ellen Vancutsem
- AIDS Reference Laboratory, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sigi Van den Wijngaert
- AIDS Reference Laboratory, Centre Hospitalier Universitaire St Pierre, Brussels, Belgium
| | - Kristel Van Laethem
- AIDS Reference Laboratory, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Clinical and Epidemiological Virology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Koen O A Vercauteren
- HIV/STD Reference Laboratory, Clinical Virology Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris Verhofstede
- AIDS Reference Laboratory, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Katrien Fransen
- HIV/STD Reference Laboratory, Clinical Virology Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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