Joanne Stekler, MD MPH; Robert W. Wood, MD; Paul D. Swenson, PhD; Matthew Golden, MD, MPH
Note added in proof: In the 5 months between acceptance and publication of this letter, 3 additional individuals have been identified who tested HIV-negative by OraQuick but HIV-positive by second-generation EIA.
Acknowledgments: The authors thank the University of Washington Primary Infection Clinic and the second individual for consenting to share follow-up HIV testing results. They also thank the AIEDRP AIN503/ACTG A5217 protocol team for allowing us to present results of the detuned EIA.
Grant Support: Dr. Stekler was funded by a National Institutes of Health grant (K23 AI65243).
Potential Financial Conflicts of Interest: None disclosed.
Stekler J, Wood RW, Swenson PD, Golden M. Negative Rapid HIV Antibody Testing during Early HIV Infection. Ann Intern Med. 2007;147:147-148. doi: 10.7326/0003-4819-147-2-200707170-00022
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Published: Ann Intern Med. 2007;147(2):147-148.
Background: Rapid HIV tests are generally considered to be as sensitive as second-generation enzyme immunoassays (EIAs) in detecting recent HIV antibody seroconversion.
Objective: To describe 3 individuals who had early HIV infection that was not identified by rapid HIV antibody testing but would have been detected by an EIA.
Case Report: The first patient had last tested negative for HIV 2 months earlier. He sought HIV testing at the Public Health–Seattle & King County (PHSKC) Sexually Transmitted Disease Clinic, Seattle, Washington, 1 week after having unprotected anal intercourse with an HIV-positive male partner. His fingerstick blood specimen was HIV-negative by the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, Pennsylvania), but his HIV RNA level was greater than 1 000 000 copies/mL (1). Retrospective testing of frozen serum was HIV-positive by a third-generation EIA (HIVAB HIV-1/HIV-2 (rDNA) EIA, Abbott Laboratories, Abbott Park, Illinois) (sample-to-cutoff ratio, 15.28), the Vironostika HIV-1 Microelisa System (bioMérieux, Durham, North Carolina) (sample-to-cutoff ratio, 6.2), and OraQuick (no sample-to-cutoff ratio). His Western blot (Genetic Systems HIV-1 Western Blot, Bio-Rad Laboratories, Hercules, California) result was positive, with bands at p24, p51, and gp160.
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