Investigation of the Pathophysiology and Diagnostic Methods Through a Case of Acute HIV Infection in which the Western Blot Method Remained Negative Over the Long Term and the 4th Generation Screening Assay Became Negative for a Certain Period of Time after Initiating Antiretroviral Therapy

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  • NIWA Kazuki
    Department of Laboratory Medicine, Tokyo Medical University Hospital Department of Infection Control, Kanto Rosai Hospital
  • YAMAMOTO Yasuuyuki
    Department of Laboratory Medicine, Tokyo Medical University Hospital
  • YOTSUMOTO Mihoko
    Department of Laboratory Medicine, Tokyo Medical University Hospital
  • CHIKASAWA Yushi
    Department of Laboratory Medicine, Tokyo Medical University Hospital
  • BINGO Masato
    Department of Laboratory Medicine, Tokyo Medical University Hospital
  • MURAMATSU Takashi
    Department of Laboratory Medicine, Tokyo Medical University Hospital
  • SEITA Ikuo
    Department of Laboratory Medicine, Tokyo Medical University Hospital
  • OTAKI Manabu
    Department of Laboratory Medicine, Tokyo Medical University Hospital
  • OGATA Kyoichi
    Department of Laboratory Medicine, Tokyo Medical University Hospital
  • HAGIWARA Tsuyoshi
    Department of Laboratory Medicine, Tokyo Medical University Hospital
  • SUZUKI Takashi
    Department of Laboratory Medicine, Tokyo Medical University Hospital
  • AMANO Kagehiro
    Department of Laboratory Medicine, Tokyo Medical University Hospital
  • KIMURA Muneyoshi
    Department of Infectious Diseases, Toranomon Hospital
  • YONEYAMA Akiko
    Department of Infectious Diseases, Toranomon Hospital
  • TAKAYA Saho
    Department of Infectious Diseases and Applied Immunology, The University of Tokyo IMSUT Hospital of The Institute of Medical Science
  • KOIBUSHI Tomohiko
    Department of Infectious Diseases and Applied Immunology, The University of Tokyo IMSUT Hospital of The Institute of Medical Science
  • KATO Shingo
    Department of Microbiology and Immunology, Keio University
  • OKAZAKI Reiko
    Department of Infection and Immunology, Nagoya Medical Center Clinical Research Center
  • HACHIYA Atsuko
    Department of Infection and Immunology, Nagoya Medical Center Clinical Research Center
  • SUGIURA Wataru
    Infectious Disease and Immunology Development and Medical Affairs Division, GlaxoSmithKline K.K.
  • FUKUTAKE Katsuyuki
    Department of Laboratory Medicine, Tokyo Medical University Hospital

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Other Title
  • 長期にわたりウエスタンブロット法が陰性で治療開始後第4 世代検査が一時期陰性化した急性HIV 感染症の1例を通した病態と診断法の検討
  • チョウキ ニ ワタリ ウエスタンブロットホウ ガ インセイ デ チリョウ カイシ ゴ ダイ4 セダイ ケンサ ガ イチジキ インセイカ シタ キュウセイ HIV カンセンショウ ノ 1レイ オ トオシタ ビョウタイ ト シンダンホウ ノ ケントウ

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Abstract

<p>Confirmatory tests using Western blot (WB) and HIV-1 nucleic acid testing (HIV-1 RNA) following a positive screening test are required for the diagnosis of HIV-1 infection according to the current Japanese guidelines for HIV-1/2 diagnosis. We report herein on a rare case in a patient who remained negative for WB over 10 months in spite of being positive by fourth-generation immunoassays (4thGIA) and who subsequently seroreverted by 4thGIA for three months after initiating antiretroviral therapy. Case： A man in his early twenties previously visited a hospital because of fever in October 2012. Laboratory data revealed leukocytopenia, thrombocytopenia and increased serum ferritin, suggesting hemophagocytic syndrome (HPS). During that visit, he tested positive for a 4thGIA, but negative for HIV-1 WB and his result of HIV-1 RNA result was detected invalid because of the presence of some inhibitory material in his RNA preparation. Thereafter, he was diagnosed as having cytomegalovirus-associated HPS treatment was for which initiated. In January 2013, he developed Pneumocystis jirovecii pneumonia, and his HIV-1 RNA viral load was 7.7 × 105 copies/mL in February 2013. Acute HIV infection was suspected, because the HIV-1 WB remained negative. He was started on antiretroviral therapy in April 2013. His 4thGIA was converted to negative in May 2013 and was reconverted to positive in August 2013. HIV-1 WB, however, continued to be indeterminant until February 2014, in which it turned positive for the first time according to the CDC criteria. Methods and Results： The genetic analyses of HIV-1 were done on the gag, env, nef and pol region of the HIV-1 gene from the patient. There was no clear element to delay antibody production on the virus side. Preserved specimens of the patient were measured with eight kinds of HIV screening assay. It was thought that the fourth generation assay was positive only by the presence of the antigen until March 2013 because the antibody had not been detected. Discussion：We encountered a case of acute HIV infection in which the WB result was negative for 10 months after the first positive response of the 4thGIA. The 4thGIA is essential for the early diagnosis and early treatment of HIV infection；therefore, the 4thGIA should be strictly recommended to avoid the use of older generations of immunoassay in the diagnostic guidelines. The role of the WB test should be examined closely from various aspects for use as a confirmatory test under recent laboratory situations in which highly sensitive and specific methods, e.g. the 4th GIA, have become available. In addition, unnecessary confusion due to the diversities of antibody formation should be avoided. The antibody detection tests for HIV are still necessary and indispensable for the confirmation of the disease or the diagnosis of the acute infection stage. Therefore development of a newer antibody measuring method which could achieve an easier operation and should have a higher sensitivity and specificity for HIV confirmation is strongly expected.</p>

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 91 (1), 7-13, 2017-01-20

    The Japanese Association for Infectious Diseases

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