AIDS in an HIV-seronegative Ghanaian woman with intersubtype A/G recombinant HIV-1 infection

Abstract

A 29-year-old Ghanaian woman who developed AIDS while being HIV-antibody seronegative was investigated during a collaborative study aimed at the identification of viral causes of a HIV-seronegative AIDS syndrome in West Africa. Plasma was screened with a panel of EIA tests for antibodies to HIV and HIV-1 p24 antigen. Retroviral infection was investigated by detection of reverse transcriptase (RT) activity in plasma, viral RNA amplification and quantification, and virus isolation. Positive amplification products were sequenced and phylogenetic analyses were carried out. Most EIA tests were unable to demonstrate the presence of anti-HIV anti-bodies, whereas confirmatory assays yielded inconclusive results. Retroviral infection was documented by detection of RT activity, HIV-1-specific genomic amplification and virus isolation. This virus was HIV-1 subtype A with an unusual six amino acid insertion in the gp120 V4 loop and with the nef gene of subtype G. The patient's plasma did not react with either autologous or heterologous viral lysates or HIV-1 peptides, whereas antibodies to other viral antigens were present. In conclusion, the Ghanaian patient exhibited a rare subtype A/G recombinant HIV-1 infection with a near absence of a HIV-specific humoral response. The lack of detectable antibody response might be due to either a highly pathogenic, rapidly fatal, HIV-1 infection preventing the development of the typical humoral immune response or to a host-related dysfunction of the immune system. Direct antigenemia or genomic detection of the virus should be undertaken when clinical or biological data suggests an HIV infection in the absence of serological evidence.

A Seronegative Case of HIV-1 Subtype C Infection in Botswana

“…Among non-B clades, HIV-1 subtype A infection was found in a persistently HIV-1-seronegative woman from Ivory Coast [7], subtype A2 virus was identified in an HIV-1-seronegative woman in Portugal [8], HIV-1 CRF01_AE (a circulating recombinant form of HIV-1 that is composed predominantly of subtype A and a unique envelope designated lineage E) was documented in 4 HIV-1-seronegative drug users in Thailand [9,10], and a rare A/G recombinant was found in an HIV-1-seronegative woman from Ghana [11]. To date, no studies, to our knowledge, have reported cases of seronegative HIV-1 subtype C infection, which is the predominant HIV-1 subtype in the worldwide epidemic.…”

“…Although the exact time and source of HIV-1 subtype C infection is unknown, it is likely that infection occurred 11 year before death. Repeated tests for HIV-1 antibodies consistently yielded negative results, including rapid and regular ELISA and Western blot.…”

Impact of frequent natural polymorphisms at the protease gene on the in vitro susceptibility to protease inhibitors in HIV-1 non-B subtypes

“…In North America and West Europe, HIV-1 subtype B is the most prevalent clade, although a rapid spreading of other variants has been highlighted in recent years (Alaeus et al, 1997a(Alaeus et al, , 1997bBarlow et al, 2001;Böni et al, 1999;Fleury et al, 2003;Holguín et al, 2000aHolguín et al, , 2000bHolguín et al, , 2002aHolguín et al, , 2002bOp de Coul et al, 2001). The diversity of HIV-1 may affect diagnostic tests (Apetrei et al, 1996;Baldrich-Rubio et al, 2001;Candotti et al, 2000), including those used for viral load measurements (Alaeus et al, 1997a(Alaeus et al, , 1997bHolguín et al, 1999;Jenny-Avital and Beatrice, 2001).…”

Virus capture using anionic polymer-coated magnetic beads (Review)

“…Serological tests for detecting antibodies against viruses in blood samples reduce, but do eliminate, the risk of viral transmission (13). For example, although the quantity of antibody against a virus may be low during the pre-seroconversion window period, the viral load can still be substantial (14)(15)(16)(17). A related detection problem exists from infection with immunovariant viruses and immunosilent carriage (18).…”