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Misdiagnosis of HIV Infection
- Josiah D. Rich, MD, MPH;
- Eleftherios Mylonakis, MD; and
- Timothy P. Flanigan, MD
- 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)
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•Type with double-spacing
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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 Unpublished letters cannot be returned.
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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.
Josiah D. Rich, MD, MPH
Brown University School of Medicine; Providence, RI 02906
Eleftherios Mylonakis, MD
Brown University School of Medicine; Providence, RI 02906
Timothy P. Flanigan, MD
Brown University School of Medicine; Providence, RI 02906
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.
- Copyright ©2004 by the American College of Physicians
