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Negative Rapid HIV Antibody Testing during Early HIV Infection
- Joanne Stekler, MD MPH;
- Robert W. Wood, MD;
- Paul D. Swenson, PhD; and
- Matthew Golden, MD, MPH
- From Public Health - Seattle and King County, and University of Washington, Seattle, WA 98195.
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 …
