Diagnostic dilemma for human immunodeficiency virus in a fatal case of acute myeloid leukemia.

Abstract

National Human Immunodeficiency Virus (HIV) testing programs utilize antibody-based tests for confirming HIV diagnosis which has a diagnostic window period of 23-90 days. In Fiebig acute HIV Stage I-II, an individual has antibody-negative but RNA-positive test results. Here, we present a case of a 54-year-old complete remission acute myeloid leukemia patient, who was recently reported HIV negative by antibody-based tests used in National HIV testing programs. However, when his sample was further analyzed by more sophisticated HIV tests, there was the presence of early anti-HIV-1 gp160 antibodies in western blot and HIV-1 RNA in nucleic acid testing. Within 8 days of his HIV-negative result, his clinical condition deteriorated. Later, the patient expired despite the best of clinical efforts at the apex tertiary care center of India. The technical difficulty in confirming HIV diagnosis by antibody-based tests used in National HIV testing programs and thereby noninitiation of antiretrovirals in a case where cell-mediated immunity is already compromised by non-HIV reason could have serious consequences. There is a need to update the existing HIV testing strategies in National HIV testing programs to include the needs of special cases.