Correspondence
False Positive Tests for HIV in a Woman with Lupus and Renal Failure
N Engl J Med 1993; 328:1281-1282April 29, 1993
- Article
To the Editor:
We recently encountered the uncommon situation of a false positive test for human immunodeficiency virus type 1 (HIV-1) during the pretransplantation evaluation of a 32-year-old Haitian woman with systemic lupus erythematosus and end-stage renal disease. Her condition had been stable with the use of hemodialysis for the previous 6 years, and she had resided in the United States for 15 years. Serologic tests were negative for cytomegalovirus, Epstein-Barr virus, herpes, toxoplasmosis, and hepatitis. Screening tests for syphilis were also negative. Both she and her husband were monogamous, with no history of drug abuse or blood transfusions. She did not have any AIDS-defining illnesses. Screening for HIV-1 showed strongly seropositive results by enzyme-linked immunosorbent assay (ELISA), which was performed three times at six-week intervals, and by Western blotting for the following antibodies: p17, p24, p31, gp41, p51, p55, p66, gp120, and gp160. The patient's absolute CD4+ counts were 130 per cubic millimeter; the total T-cell and CD8 counts were normal. She vehemently denied any risk factors for HIV infection and had heard at a lupus support group that she could test positive for HIV-1 as a result of a “universal antibody.” Since she very much wanted a renal transplant, we extended the evaluation to include p24 antigen testing, the polymerase chain reaction (PCR) (performed at the New York Blood Center), and viral culture (done at Mount Sinai Medical Center, New York), all of which were negative. We speculate that the false positive test may have been due to the presence of autoantibodies related to the systemic lupus erythematosus. The patient is now on the waiting list for a kidney transplant.
Autoantibodies are frequently found in patients with systemic lupus erythematosus. These autoantibodies often lead to false positive results on syphilis (Venereal Disease Research Laboratory) tests or to abnormal results on a coagulation test (with a prolonged partial-thromboplastin time) because of the presence of serum cardiolipin1. Leo-Amador et al.2 reported the results of serologic tests in 70 patients with systemic lupus erythematosus. Four were positive for HIV-1 by ELISA, but on repeat testing only two remained positive. They did not perform PCR or viral culture on specimens from the two patients with consistently positive results.
Our patient with systemic lupus erythematosus and end-stage renal disease clearly had a false positive test for HIV-1. We reviewed our files for the past five years for other patients with systemic lupus erythematosus who were evaluated for kidney transplantation. None of them had a false positive test for HIV-1. We recommend that patients with systemic lupus erythematosus and end-stage renal disease who have a positive result on ELISA and Western blotting undergo further study, including PCR and culture for HIV-1.
2 ReferencesR. Jindal, M.D., F.R.C.S.(Ed.), M.Sc.
M. Solomon, R.N.
L. Burrows, M.D.
Mount Sinai School of Medicine, New York, NY 100291
Chapel H, Haeney M. Essentials of clinical immunology. 2nd ed. Oxford, England: Blackwell Scientific, 1988:236-42.
2
Leo-Amador GE ,Ramirez-Rodriguez JM ,Galvan-Villegas F ,Perla-Navarro AV . Anticuerpos contra el virus de la immunodeficiencia humana en lupus eritematoso generalizado. Salud Publica Mex 1990;32:15-19
Medline
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Michael E. Jones. (1999) HIV and the Returning Expatriate. Journal of Travel Medicine 6:2, 99-106
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Kris V. Kowdley, David E. Subler, James Scheffel, Bonnie Moore, Howard Smith. (1997) Hepatitis C Virus Antibodies in Systemic Lupus Erythematosus. Journal of Clinical Gastroenterology 25:2, 437-439
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Soriano, Vicenc, , Ordi, Josep, , Grau, Josep, . (1994) Tests for HIV in Lupus. New England Journal of Medicine 331:13, 881-881
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Povolotsky, Jacob, Polsky, Bruce, , Laurence, Jeffrey, , Jindal, R., Rozon-Solomon, Maritza, Burrows, Lewis, . (1994) Withdrawal of Conclusion: False Positive Tests for HIV in a Woman with Lupus. New England Journal of Medicine 331:13, 881-882
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BONNIE L. BERMAS, MICHELLE PETRI, JAY A. BERZOFSKY, ARIE WAISMAN, GENE M. SHEARER, EDNA MOZES. (1994) Binding of Glycoprotein 120 and Peptides from the HIV-1 Envelope by Autoantibodies in Mice with Experimentally Induced Systemic Lupus Erythematosus and in Patients with the Disease. AIDS Research and Human Retroviruses 10:9, 1071-1077
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