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Seto N, Fukuchi T, Kawakami M, Nagashima M, Sadamasu K, Hatakeyama S. Seronegative HIV-1 infection in a Japanese man presenting with Pneumocystis pneumonia: Analysis of long-term antibody response and literature review. J Infect Chemother 2024; 30:917-921. [PMID: 38331251 DOI: 10.1016/j.jiac.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/28/2024] [Accepted: 02/03/2024] [Indexed: 02/10/2024]
Abstract
Seronegative human immunodeficiency virus (HIV) infection, where an HIV-specific antibody response is lacking even in chronic or late-stage HIV infections, is extremely rare. Here, we report the case of a 50-year-old Japanese man presenting with Pneumocystis pneumonia who did not produce antibodies against HIV-1 until the initiation of antiretroviral therapy (ART). Fourth-generation antigen-antibody testing temporarily reverted from weakly positive to negative soon after initiating ART, likely due to a reduction in viral load (assessed by p24 antigen levels). His HIV-1 antibody titers remained low or indeterminate even after four years of ART. A literature review suggested that the absence of HIV-1-specific antibody production may be associated with unimpeded HIV replication and rapid CD4+ T cell decline. Seronegative HIV infection can lead to deferred diagnosis and treatment, thereby increasing the risk of transmitting the virus to others or developing opportunistic illnesses. It is important to combine multiple tests for diagnosis, depending on the medical condition. Further studies are required to investigate the host factors involved in the production of HIV-1-specific antibodies.
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Affiliation(s)
- Nayuta Seto
- Division of General Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Takahiko Fukuchi
- Division of General Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Mamiyo Kawakami
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Mami Nagashima
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Kenji Sadamasu
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Shuji Hatakeyama
- Division of Infectious Diseases, Department of Infection and Immunity, Jichi Medical University, Tochigi, Japan; Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
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Lee EJ, Kim YH, Lee JY, Sunwoo JS, Park SY, Kim TH. Acute HIV-1 infection presenting with fulminant encephalopathy. Int J STD AIDS 2017; 28:1041-1044. [PMID: 28201953 DOI: 10.1177/0956462417693734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Human immunodeficiency virus (HIV)-1 directly affects the nervous system, causes distinct neurological symptoms, and indirectly results in opportunistic infections, which include herpes virus simplex (HSV)-1, HSV-2, varicella zoster virus, and cytomegalovirus encephalitis caused by immunodeficiency. Early HIV-1 invasion of the central nervous system is also possible, and acute encephalopathy is a potentially lethal complication. We encountered a case of fulminant encephalopathy as a primary presentation of acute HIV-1 infection, in which highly active antiretroviral treatment resulted in a full clinical recovery. This case highlights the importance of considering acute HIV-1 infection in the differential diagnosis of reversible encephalopathy.
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Affiliation(s)
- Eun J Lee
- 1 Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Young H Kim
- 1 Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Jeong Y Lee
- 2 Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea
| | - Jun-Sang Sunwoo
- 2 Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea
| | - Se Y Park
- 1 Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Tae H Kim
- 1 Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
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Zhang H, Wang HL, Zhong DR, Liu Y, Li NN, Zhang W, Xiao Y, Li TS. Fatal pulmonary Kaposi sarcoma in an HIV seronegative AIDS patient. CLINICAL RESPIRATORY JOURNAL 2016; 11:1040-1044. [PMID: 26861193 DOI: 10.1111/crj.12463] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 01/15/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although HIV antibody tests have been widely accepted in clinical diagnosis of HIV infection, they may not be sufficient to diagnose all subjects with HIV infection. Except negative result of antibody test in the well-known" acute window phase", in rare cases, patients do not develop HIV antibodies despite demonstrable infection. Primary pulmonary Kaposi sarcoma (KS) without mucocutaneous involvement accounts for only 0-15% of all AIDS-related KS. KS is rare among Chinese subjects, especially in persons of Han descent. METHODS A case of seronegative AIDS with primary pulmonary Kaposi sarcoma (KS) was reported. It's a 46-year-old Chinese man presented with sore throat, hemoptysis, fever, dyspnea and multiple lung nodules. The lung lesions grew over a 5-month period so as the symptoms worsened. The possibility of AIDS was discounted by his physicians because of the repeatedly negative HIV antibodies tests despite the ELISA tests or Western blot tests. Histopathologic diagnosis of fine needle lung biopsy in local hospital was undetermined. After admission, HIV infection was eventually confirmed by plasma HIV RNA testing. Histopathologic diagnosis of Lung Kaposi sarcoma was made through repeated fine needle aspiration biopsy as well as the review of former one. Multiple antibiotics and chemotherapy were administrated with no clinical effect due to advanced stage and the patient passed away soon after diagnosis. RESULTS This is the first case of seronegative HIV-1 infection with presentation of primary pulmonary KS. CONCLUSION This case underscores the importance of plasma RNA test in conjunction with HIV antibody test for some rare patients with HIV infection who present with severe immunodeficiency and opportunistic infections or malignancy.
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Affiliation(s)
- Hong Zhang
- Departments of Respiratory Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Huan-Ling Wang
- Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ding-Rong Zhong
- Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yan Liu
- Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ning-Ning Li
- Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wei Zhang
- Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yi Xiao
- Departments of Respiratory Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Tai-Sheng Li
- Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
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Nzwalo H, Añón RP, Àguas MJ. Acute encephalitis as initial presentation of primary HIV infection. BMJ Case Rep 2012; 2012:bcr.03.2012.5970. [PMID: 22761210 DOI: 10.1136/bcr.03.2012.5970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute encephalitis is a life-threatening condition. A wide variety of infectious agents are implicated and in many patients no cause is found. HIV acute seroconversion illness can rarely present as acute encephalitis. Although most experts agree in starting antiretroviral treatment in severe acute HIV infection, the evidence of the benefits are still lacking. The authors report a case of severe acute encephalitis as a primary presentation of HIV infection in which introduction of highly active antiretroviral treatment resulted in clinical recovery. This case highlights the need to consider HIV infection in the differential diagnosis of treatable viral encephalitis.
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