False negative HIV-1 proviral DNA polymerase chain reaction in a patient with primary infection acquired in Thailand.

Abstract

Qualitative HIV-1 proviral DNA PCR tests have three main diagnostic applications. These include direct detection of viral sequences in the pre-seroconversion window period which may be positive up to 8 days prior to the development of HIV specific antibodies; resolution of indeterminate HIV serological tests and in the diagnosis of neonates born to seropositive mothers where maternal antibodies may be detectable for up to 15 months past partum. A total of three serial specimens from a single patient following symptomatic primary HIV-1 infection were assessed by commercially available serological assays for antibodies to HIV and HIV-1 antigen and nucleic acid amplification assays for proviral DNA (Amplicor HIV-1 test, Roche Molecular Systems, CA, USA) and RNA (HIV MONITOR ver1.5, Roche Molecular Systems) according to manufacturers recommendations. A subsequent modified PCR protocol for HIV proviral DNA was performed which included modified primers (SK145/SKCC1B) and altered thermal cycling parameters. We describe a case of HIV infection acquired in Thailand by heterosexual transmission, where a commercially available HIV proviral DNA PCR assay remained negative despite a typical evolving serological profile consistent with seroconversion. These data support the use of HIV DNA PCR tests only as a second line supplemental test to licensed standard HIV diagnostic testing strategies, and should be used with care in cases where non-B subtype infection is a possibility.