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Seronegative HIV Infection

A case report serves as a reminder that such infection does occur, sometimes with fatal consequences.

Seronegative HIV infection has been described previously but is quite unusual. In this brief report from Portugal, investigators described the phylogenetic analysis of a virulent HIV strain that resulted in a patient's rapid progression to AIDS and death.

The patient was a previously healthy 20-year-old heterosexual man who presented with fatigue and weight loss. Testing for infectious diseases, including serologic assays to detect antibodies to HIV-1 and HIV-2, provided no answers. Within 3 months, the patient developed oropharyngeal candidiasis, and his CD4 count dropped to 232 cells/mm³. HIV serology continued to be negative, even when his CD4 count dropped further, to 52 cells/mm³. Serum p24 antigen levels and plasma viral load were consistent with HIV infection. Within 6 months of his original presentation, he died of AIDS.

Immediately before symptom onset, the patient had a 3-month relationship with a woman who was a sex worker and injection-drug user. She, too, experienced an aggressive course of disease, presenting with a CD4 count of 40 cells/mm³ and succumbing to AIDS within 21 months. In her case, serologic testing did reveal HIV infection.

Phylogenetic testing confirmed that both patients were infected with a B/G recombinant variant that resembled a strain previously detected among injection-drug users in Spain and Portugal. Based on the presence of a heterogeneous virus population in the woman and a single virus population (all CCR5-tropic) in the man, researchers determined that transmission occurred from the woman to the man.

Comment: This case report serves as a reminder that when patients with symptoms of HIV infection have negative results on antibody tests, we should pursue additional virus-specific tests (such as viral load). HIV-infected individuals can be seronegative for a number of reasons, including seroreversion, late seroconversion, evaluation during the window period, and defects in the immune system that prevent development of a humoral response to infection. Also notable in this report is the finding that a genetically uniform population of CCR5-tropic variants can cause rapidly progressive, fatal HIV infection, a course generally thought to be associated with CXCR4-expressing variants.

— Sonia Nagy Chimienti, MD

Published in Journal Watch HIV/AIDS Clinical Care November 23, 2009

Citation(s):

Bártolo I et al. Rapid clinical progression to AIDS and death in a persistently seronegative HIV-1 infected heterosexual young man. AIDS 2009 Nov 13; 23:2359.

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Reader Remarks:

Review and add to remarks on this article

• seronegative hiv
  Dr. Saka Venkat Satya Prasad, govt, 24 Nov 2009 3:45 PM EST
  Its interesting to note that that HIV status as positive or negative is taking a new turn.It has also been... [more]
• An intresting case for doctors of developing countries.
  Kewal Krishen Thassu, 24 Nov 2009 3:45 PM EST
  It is a very intresting case.In countries like India and other developing countries where O.P.D. Pt load is very high... [more]
• law point of view
  Daniela Gavrailova Nikolova, Clinic of infectious diseases, 24 Nov 2009 3:45 PM EST
  It is very interesting case from law-point of view to switch on antiretroviral therapy in such a patient.
• Clinician Insight
  Muzafar Ahmed Naik, SKIMS MEDICAL COLLEGE, 1 Dec 2009 2:32 PM EST
  Its really interesting and reminds that laboratories should not mastermind clinicians rather clinicians should mastermind the labs.

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