Diagnosis and Staging of an Acute HIV Infection by resolving unconformities: A case study

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Neval Yurttutan-Uyar, Tolga Eroğlu, Hakan Ü. Ünal, Sesin Kocagöz, Murat Saruç

Abstract

Background: Acute Retroviral Syndrome (ARS) is the syndromic presentation of primary acute severe HIV infection.


Objectives: Either technical challenges at HIV tests, or clinical complexity complicate the diagnosis of indeterminate immunodeficiency cases as ARDS, especially if the patient who had no risk factors for immunosuppression or HIV infection and periodically checked for HIV tests


Methods: The patients was tested Anti-HIV antibody screening test with Siemens ADVIA Centaur (Siemens, Erlangen, Germany), Abbott Architect (Abbott, Illinois, USA)) and VIDAS HIV DUO Ultra (BioMérieux, (Marcy l'Etoile, France). Anti-HIV antibody was confirmed by confirmation tests Geenius HIV1/2 Confirmatory Assay (Geenius, Bio-Rad, CA, US) and INNO/LIA HIVI/II Score (INNO, Fujirebio, (Ghent, Belgium)), gave negative results. Then HIV1-RNA was tested with Qiagen (Venlo, Netherland).


Results: Anti-HIV screening test resulted in positive (Siemens ADVIA Centaur (Siemens, Erlangen, Germany)). Moreover, two different manufacturers’ additional HIV screening tests (Abbott Architect (Abbott, Illinois, USA)) and VIDAS HIV DUO Ultra (BioMérieux, (Marcy l'Etoile, France)) resulted positive. VIDAS revealed HIV1/2 antibody positivity and none determined (ND) p24 antigen. Antibody confirmation tests (Geenius HIV1/2 Confirmatory Assay (Geenius, Bio-Rad, CA, US)) and INNO/LIA HIVI/II Score (INNO, Fujirebio, (Ghent, Belgium)), gave negative results. HIV1-RNA resulted in 1.343.342.808 copies/mL after serum dilution


Conclusions: By following the CDC recommendation, the patient diagnosed as HIV positive. And by solving the inconsistency of HIV test results between positive screening (antigen:nd, and antibody:positive) and negative antibody confirmation and by following the diagnostic algorithm, the patient could be diagnosed as Fiebig stage III Acute HIV infection, ARS. The discrepancy were solved by using special technics as dilution, heat inactivation, and Ethylenediaminetetraacetic acid (EDTA) usage

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