HIV‐1 Causing AIDS and Death in a Seronegative Individual

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

“…Only detection of the virus itself, either with p24 antigen EIA or by genomic amplification could provide a definite diagnosis. Although such occurrence is rare, all cases of immunosilent AIDS described previously, and our data, indicates that HIV seronegative patients with clinical AIDS are p24 antigen positive [Oka et al, 1994;Soriano et al, 1994;Martin-Rico et al, 1995;Wegner et al, 1995;Michael et al, 1997;Montagnier et al, 1997;Sullivan et al, 1999]. The recent release of assays detecting simultaneously HIV antibody and p24 antigen may meet the need to detect such cases, including in developing countries.…”

“…A third possibility of missed HIV diagnosis is "immunosilence." To our knowledge, only a few cases of established HIV-1 infection undetected with commercial antibody screening assays have been described [Oka et al, 1994;Soriano et al, 1994;Martin-Rico et al, 1995;Wegner et al, 1995;Michael et al, 1997;Montagnier et al, 1997;Ellenberger et al, 1999;Kopko et al, 1999;Sullivan et al, 1999]. These apparently immunosilent patients have been investigated and, the lack of antibody production was generally attributed to host factors [Ellenberger et al, 1999]; either the complete absence of CD4 + cells in the peripheral blood impairing antibody production [Wegner et al, 1995;Montagnier et al, 1997], or a particularly low level of immune resistance to the infection [Michael et al, 1997].…”

No evidence of a significantly increased risk of transfusion‐transmitted human immunodeficiency virus infection in Australia subsequent to implementing a 12‐month deferral for men who have had sex with men (CME)

“…The HIV residual risk is almost entirely associated with donations taken from donors in the very early phase of infection (the so called “window period”[WP]) 40 . Importantly, as highlighted by Vamvakas 22 all cases of HIV infection result in the development of detectable HIV antibody, p24 antigen, and/or HIV RNA within 12 months 41‐43 . The implementation of HIV‐1 NAT in Australia in 2000 44 reduced the estimated HIV WP from approximately 22 days (for the existing HIV antibody assay) to approximately 9 days 45 .…”

Early Identification of Seronegative Human Immunodeficiency Virus Type 1 Infection with Severe Presentation

“…Otherwise, seronegativity is attributed to the aggressive disease course and the associated immunological dysfunction in patients whose disease course is rapid and severe (10,13). However, the loss of antibody cannot be distinguished from the lack of antibody formation because antibody testing is first performed late in the course of the disease in most reported seronegative cases (7,10,13,17). In actuality, seroreversion occurs in very rare instances (14), although incomplete HIV-1 antibody evolution and seroreversion have been observed in acutely infected individuals who receive early antiretroviral therapy (5).…”