Repeated false reactive ADVIA centaur® and bio-rad Geenius™ HIV tests in a patient self-administering anabolic steroids

Abstract

Background: An individual is considered HIV positive when a confirmatory HIV-1/HIV-2 differentiation test returns positive following an initial reactive antigen/antibody combination screen. Falsely reactive HIV screens have been reported in patients with various concomitant infectious and autoimmune conditions. Falsely positive confirmatory HIV differentiation assays are seen less frequently, but have been observed in cases of pregnancy, pulmonary embolism, and malaria. Case presentation: A healthy 27 year-old man was referred after a reactive ADVIA Centaur® HIV Ag/Ab screen and positive Bio-Rad Geenius™ HIV 1/2 Confirmatory assay, suggesting HIV-1 infection. The patient's HIV viral load was undetectable prior to initiation of antiretroviral therapy, and remained undetectable on subsequent testing after initiation of antiretroviral therapy. Both Centaur® and Geenius™ tests were repeated and returned reactive. As this patient was believed to be at low risk of acquiring HIV infection, samples were additionally run on Genscreen™ HIV-1 Ag assay and Fujirebio Inno-LIA™ HIV-1/2 score, with both returning non-reactive. For confirmation, the patient's proviral HIV DNA testing was negative, confirming the initial results as being falsely positive. The patient disclosed that he had been using a variety of anabolic steroids before and during the time of HIV testing. Discussion and conclusions: The erroneous diagnosis of HIV can result in decreased quality of life and adverse effects of antiretroviral therapy if initiated, hence the importance of interpreting the results of HIV testing in the context of an individual patient. This reports suggests a potential association between the use of anabolic steroids and falsely-reactive HIV testing.

False reactive HIV-1 diagnostic test results in an individual from Kenya on multiple testing platforms-A case report

“…The 4thG IA results consistently reflected those of DET-Ag/Ab RDT, and was observed at multiple time points and across two different testing laboratories. False HIV reactivity using 4thG IA has previously been reported for several different commercial 4thG IA [ 12 , 14 , [20] , [21] , [22] ] and the current study extends this to an additional manufacturer. The 4thG IA used in this study saturates at a S/CO of 12–16 [ 23 ], so all values above observed in this study were unequivocally reactive.…”

“…HIV-1 infection was later ruled out using alternative HIV-1 serologic and nucleic acid tests with ART cessation after 4 months. HIV false-reactivity was attributed to use of anabolic steroids [ 22 ]. The participant in RV393 did not report using any form of steroids.…”

Does testosterone intake affect diagnosing primary HIV infection?

“…In enzyme-linked immunosorbent assay (ELISA) test, false-positive results can occur, e.g. due to autoimmune diseases, pregnancy, or infections such as acute malaria [3][4][5]. Additionally, false-negative results were reported in association with agammaglobulinemia and testing within the window period.…”

“…As previously mentioned, the diagnosis of HIV infection may be disrupted by other infections, pregnancy, autoimmune diseases, medications, and exogenous steroids taken by the patient [3,12,13]. Exogenous testosterone is broadly used by individuals with decreased hormone levels, as in Klinefelter Syndrome, and those who want to improve their muscle mass and body image.…”