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1994-10-25
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Document 2740
DOCN M94A2740
TI Seroreversion in patients with end-stage HIV disease.
DT 9412
AU Gutierrez M; Soriano V; Bravo R; Vallejo A; Gonzalez-Lahoz J; Service of
Microbiology, Instituto de Salud Carlos III, Madrid,; Spain.
SO Int Conf AIDS. 1994 Aug 7-12;10(1):235 (abstract no. PB0370). Unique
Identifier : AIDSLINE ICA10/94369835
AB Diagnosis of HIV infection depends primarily on detection of specific
antibodies (Ab). High HIV-Ab levels generally persist until late in the
course of infection when HIV-Ab to core antigens may decrease,
reflecting: 1) insufficiency of the perturbed immune system to sustain
an adequate humoral response; and 2) immune complex formation secondary
to overproduction of HIV antigens. Seroreversion from positive for
antibodies to HIV to negative can have far-reaching effects, leading to
misidentification of persons which can unnoticedly transmit the virus to
contacts, and whom cannot be benefied themselves from antiretroviral and
prophylactic therapies. We analyzed the serological reactivity of 29
subjects (25 men and 4 women; mean age 32) fulfilling criteria for AIDS,
and whom had positive PCR for specific HIV-1 genomic sequences. All them
were hospitalized and had less than 50 CD4+ cells/microL. Ten (34%) died
during the next 3 months of the study. They acquired HIV infection
through intravenous drug addiction practices (n = 18), homosexual
contacts (n = 8), and heterosexual relations (n = 3). Sera from all them
were reactive by third-generation ELISA, and any in the cut-off range.
HIV antigenemia was detected in 18 (62%) of sera. Reactivity on line
immunoassay (LIA) was present in all samples, even though one showed
very weakly reactivity. On Western blot (WB) analysis, 4 sera showed
exclusive reactivity to one band (gp160 in all them). In addition, 3
samples only showed reactivity to several env bands. More than a half of
sera were indeterminate by WB using CDC, FDA, ARC, and CRSS WB
interpretation criteria. The WHO WB interpretation criteria (which
requires env reactivity alone to considers positivity) yielded the
higher sensitivity. Acid pre-treatment of sera allowed to partial
recovery of gag and pol bands on WB strips in many sera. CONCLUSION:
Absolute seroreversion, if exist, seems to be a very rare phenomenon.
However, indeterminate results on WB and likely on first-generation
ELISAs are common in patients with very advanced HIV disease, as a
result of a loss of Ab to core proteins.
DE Acquired Immunodeficiency Syndrome/CLASSIFICATION/*DIAGNOSIS/
IMMUNOLOGY Adult Blotting, Western Enzyme-Linked Immunosorbent Assay
Female Human HIV Antibodies/BLOOD HIV Antigens/BLOOD HIV
Seropositivity/CLASSIFICATION/*DIAGNOSIS/IMMUNOLOGY *HIV-1 Leukocyte
Count Male Polymerase Chain Reaction T4 Lymphocytes/IMMUNOLOGY
MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).