Misdiagnosis of HIV Infection by HIV-1 Plasma Viral Load Testing: A Case Series

RTB: Which Test is a Test? The Viral Load test is not standardized, gives variable, non-diagnostic results, that are interpreted against the clinical view of the patient: If they think you are an AIDS patient, they will value the test.

Each of these individuals tested “positive” on Viral Load tests and negative on other HIV tests. The tests are poly-reactive, non-standardized and non-diagnostic. Despite all of this, the authors put forward the notion that the antibody tests (ELISA and Western Blot) are quite good. But Western Blot has been phased out because it gives too many ‘indeterminate’ test results, and has no standard for interpretation, and Viral Load is used to “confirm” antibody testing.

The authors add: “Only patients who have a high pretest probability of a positive result should be evaluated for primary HIV infection using plasma viral load testing.” In other words, unless the clinician believes that someone is immune suppressed, or in a group considered to be “at risk” for AIDS (Gays, Blacks, drug addicts), the individual should not be tested with Viral Load.

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CASE 1.

A previously healthy 12-year-old boy, whose HIV-infected mother is cared for at one of our institutions, presented for evaluation of a positive plasma viral load (PCR) of 1254 copies per/mL determined by using the branched-chain DNA assay (Chrion) for HIV-1 RNA.

The patients’ mother had received a diagnosis of HIV infect around the time of his birth, and the patient had tested negative for HIV-1 by enzyme-linked immunosorbent assay (ELISA) several times in the years after his birth.

Although the patient reported no risk factors for HIV infection, he underwent plasma viral load testing after his primary care physician noted a skiing lesion that was interpreted as herpes zoster. At our institution, the patient subsequently had a negative result on HIV-1 ELISA, a normal CD4 cell count and a CD4:CD8 ration, and a negative plasma viral load…His skin lesion was diagnosed as impetigo, and he remains in excellent health 3 months after his initial presentation.

The patient tested negative for HIV-1 antibody on (an) HIV-1 oral specimen collection device..


CASE 2.

A previously healthy, pregnant 40-year-old woman presented for an HIV test. Her male sexual partner, with whom she had recently had repeated unprotected vaginal intercourse, had been given a diagnosis of HIV infection 1 week before her office visit.

The patient tested negative for HIV-1 antibody on (an oral test)…but continued to be concerned about her HIV status.

One week after her initial presentation, she underwent a plasma viral load test… that yielded a positive value of 1574 copies/mL. The patient was told shat she was probably infected with HIV.

During the next 3 months, she had a negative result on an HIV-1 ELISA, a normal CD4 cell count…and three HIV-1 plasma viral load tests …that showed an undetectable viral load. When the patient delivered a healthy baby 7 months after her initial presentation, another HIV-1 ELISA yielded negative results.

CASE 3

A 20-year-old healthy woman…had a positive result on HIV-1 ELISA and an indeterminate result on a Western blot test.

During a 4-month period after her indeterminate result on the WB test, she had a positive result on ELISA and an indeterminate result on a Western blot test on separate occasions.

Five months later, both ELISA and a Western blot test yielded negative results, but the patient had a plasma viral load of 1300 copies/mL. (Roche PCR test).

She was subsequently counseled that she was probably infected with HIV. Nearly 6 months after her initial indeterminate HIV test result, she was tested by a third laboratory and was negative for HIV-1 antibodies on both ELISA and Western blot test.

She had a normal CD4 cell count.. and a plasma load that was undetectable on RT-PCR (Roche Viral Load tees).

She remains healthy 8 months after her initial presentation.

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