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  • 1.  HIV Test and Diagnosis

    Posted 06-14-2023 16:50

    Hi everyone,

    I have a patient who has consistently tested positive for HIV 1 for more than a year.

    HIV 1 ANTIBODY
    Non Reactive    Reactive 
    HIV 2 ANTIBODY
    Non Reactive    Non Reactive 
    HIV GEENIUS RESULT    HIV-1 Positive Abnormal  
    Comment: Laboratory evidence consistent with HIV-1 infection.

    The viral load is consistent <20 for the past year.

    HIV VIRAL LOAD
    copies/mL    <20 
    Comment:                HIV-1 RNA not detected 
                                                          . 
    The reportable range for this assay is 20 to 10,000,000 
    copies HIV-1 RNA/mL. 

    I have a few questions. Should this patient be diagnosed with HIV or not?

    Is there an additional test I should do?

    Should the patient be on medications?

    Your opinions are needed and welcome.

    Thanks



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    Faith Richard
    Cleveland OH
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  • 2.  RE: HIV Test and Diagnosis

    Posted 06-15-2023 13:06

    HI there  

    I think you may want to order a Genosure Pro Viral DNA (Archive) to see if there is HIV DNA present.  He may be an elite controller or actually HIV negative. 



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    Emily Rymland
    [Director of Clinical Operations Nurx
    [SF] [CA ]
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  • 3.  RE: HIV Test and Diagnosis

    Posted 06-15-2023 14:53

    Hello everyone,

    I have a similar situation as that presented by Faith Richard, only in my patient's case (he is on PrEP), his repeatedly reactive HIV Ag/Ab test consistently reflexes with both HIV 1 and HIV 2 Antibody (both negative) and lastly an HIV RNA (also negative). This has been the pattern every 3 months since September 2022. Should I likewise search for Viral DNA as you suggested, Emily?



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    Kyle Duff
    Bridgeville PA
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  • 4.  RE: HIV Test and Diagnosis

    Posted 06-15-2023 16:28

    Faith- for your patient, based on what I can tell from what you shared, the confirmatory test is reactive. I'd recommend testing an HIV DNA quant/qual to see if any DNA is detected as it appears as though this person is HIV positive and is an elite controller (i.e., HIV 1 ab reactive, confirmatory test reactive for HIV 1, but HIV RNA undetectable/<20). I would expect the HIV DNA to be positive/quantifiable. I'd also check a CD4 as well as baseline recommended labs for people with HIV.

    I recommend starting ART to minimize inflammation and preserve immune function. From the HIV guidelines: "Given that ongoing HIV replication occurs even in elite controllers, ART is strongly recommended for controllers with evidence of HIV disease progression, which is defined by declining CD4 counts or the development of HIV-related complications (AIII). Nonetheless, even elite controllers with normal CD4 counts show evidence of abnormally high immune activation and surrogate markers of atherosclerosis, which may contribute to an increased risk of non-AIDS–related diseases." 

    Kyle- if your patient's HIV screens come back positive or indeterminate, but the confirmatory is negative, I'd feel confident saying they don't have HIV. However if you have a strong suspicion they are HIV positive despite the negative HIV RNA, you could check an HIV DNA quant or qual to confirm.

    Hope that helps! 😊



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    Carly Floyd
    Albuquerque NM
    CaCloud@salud.unm.edu
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  • 5.  RE: HIV Test and Diagnosis

    Posted 06-15-2023 17:18
    Edited by Faith Richard 06-15-2023 17:19

    Thanks for your response Carly. The HIV conference I attended last year, this information was shared. I learnt the same thing about Elite Controllers, and your response is the confirmation that I needed to proceed with treatment after additional test confirms the diagnosis. This is the first time I am dealing with a case like this.



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    Faith Richard
    Cleveland OH
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  • 6.  RE: HIV Test and Diagnosis

    Posted 06-15-2023 17:21
    Edited by Faith Richard 06-15-2023 17:21

    I appreciate your response, Emily. This is the first case that I am dealing with where viral load is undetectable with a positive HIV test.



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    Faith Richard
    Cleveland OH
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  • 7.  RE: HIV Test and Diagnosis

    Posted 06-16-2023 15:41

    Is your patient on PrEP?  If so, it's possible the Descovy or Truvada alone is virally suppressing undiagnosed HIV infection (it happened with one of our cases), or as others say, an elite controller.    



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    Joshua Rohr
    Seattle WA
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