 Article
|
|
|
|
Services
|
|
|
|
Google Scholar
|
|
|
|
PubMed
|
|
|
|
REPLY
Misdiagnosis of HIV Infection
Josiah D. Rich, MD, MPH;
Eleftherios Mylonakis, MD; and
Timothy P. Flanigan, MD
5 October 1999 | Volume 131 Issue 7 | Pages 547-548
IN RESPONSE:
Dr. Palmas suggests that different levels of diagnostic sensitivity (1) could help minimize false-positive results. Prospective studies can evaluate this issue and quantify the frequency of misdiagnosis of HIV infection by HIV-1 plasma viral load testing. In the meantime, physicians should use caution in diagnosing HIV infection solely on the basis of a detectable HIV-1 plasma viral load. However, we continue to encourage efforts to rapidly and accurately diagnose acute HIV infection. This is a responsibility for all care providers, not just specialists in the field.
Goodman and colleagues describe the converse situation, in which an undetectable HIV-1 plasma viral load is found in persons who are HIV infected but not receiving antiviral therapy. The authors report that 13 of the HIV-infected patients in their cohort had plasma viral loads less than 400 copies/mL and that 6 had an undetectable plasma viral load on ultrasensitive assay. All of these patients had preserved CD4 cell counts and percentage of CD4 cells and normal ratio of helper to suppressor cells. These persons may become long-term nonprogressors, although they have not had a sufficient duration of follow-up (2). Using HIV-1 plasma viral load testing to diagnose HIV-1 infection can also provide false-negative results. Laboratory data should be interpreted on the basis of the clinical scenario and are not a substitute for vigilant clinical evaluation that combines serologic and plasma viral load testing with clinical follow-up.
|
Author and Article Information
|
|---|
Brown University School of Medicine; Providence, RI 02906 (Rich)
Brown University School of Medicine; Providence, RI 02906 (Mylonakis)
Brown University School of Medicine; Providence, RI 02906 (Flanigan)
1. Saah AJ, Hoover DR. "Sensitivity" and "specificity" reconsidered: the meaning of these terms in analytical and diagnostic settings Ann Intern Med. 1997;126:91-4.[Free Full Text]
2. Kirchhoff F, Greenough TC, Brettler DB, Sullivan JL, Desrosiers RC. Absence of intact nef sequences in a long-term survivor with nonprogressive HIV-1 infection N Engl J Med. 1995;332:228-32.[Free Full Text]
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Related articles in Annals:
-
Brief Communications
Misdiagnosis of HIV Infection by HIV-1 Plasma Viral Load Testing: A Case Series
Josiah D. Rich, Nathan A. Merriman, Eleftherios Mylonakis, Thomas C. Greenough, Timothy P. Flanigan, Brian J. Mady, AND Charles C.J. Carpenter
- Annals 1999 130: 37-39.
[ABSTRACT][Full Text]
Top
Author & Article Info
References