Repeated false-negative HIV rapid test results in a patient presenting to care with advanced HIV disease: A case report

Chuwa, Francisca; Kivuma, Bernard; Ndege, Robert

doi:10.1016/j.idcr.2023.e01719

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Severe immunosuppression condition could be one of the factors causing false negative in advanced HIV. 11 The development of next generation HIV testing methods could further reduce the false negative risk. 12 The clinical presentation of PJP in patients with HIV is characterized by the subacute onset of dyspnea, fever, and nonproductive cough.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic challenge of Pneumocystis jirovecii pneumonia infection mimicking interstitial lung disease in initially HIV negative patient

Kristy,

Yaniswari

2023

JPMS

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Background: Pneumocystis jirovecii pneumonia (PJP) infections are common in immunocompromised patients and are rarely found in immunocompetent patients. Lung radiology in PJP patients could mimic the appearance of interstitial lung disease (ILD) and could be used to diagnose HIV-negative patients. Clinicians should rule out false negatives in patients with patterns suggestive of opportunistic infections and risk factors for HIV infection. Case illustration: A 34-year-old man presented with a chief complaint of shortness of breath, had history of 15 years of smoking, and daily chlorine exposure. The radiology pattern and initial HIV-negative test results suggested an ILD diagnosis. Owing to persistent symptoms despite initial management and the presence of risk factors, repeat HIV testing was initiated and was positive. The patient was treated with cotrimoxazole and showed rapid clinical improvement. Discussion: The diagnosis of PJP in our patient was based on radiology and an HIV-positive status. In patients who are not immunocompromised, the diagnosis of PJP is unlikely, and other diagnoses, such as ILD, should be considered. However, in the HIV testing window period of infection, a poor advanced state of HIV could cause a false negative result. Therefore, clinical judgement is essential in suspecting such a result. The empirical treatment course of cotrimoxazole has been shown to provide better clinical outcomes in PJP. Conclusion: The possibility of PJP must be considered in patients with initially HIV-negative results, especially in patients with risk factors and clinical symptoms suggestive of immunocompromise. While some ILD showed similar PJP, the risk factors for ILD and PCP could be distinguishing factors. Retesting for HIV infection can confirm the diagnosis and rule out false-negative results.

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Section: Discussionmentioning

confidence: 99%

Diagnostic challenge of Pneumocystis jirovecii pneumonia infection mimicking interstitial lung disease in initially HIV negative patient

Kristy,

Yaniswari

2023

JPMS

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“…Letter: Sero-negative HIV, first described within 6 years of the discovery of HIV as the cause of AIDS [1], continues to be disregarded despite an increasing number of reported cases, and associated high mortality [2][3][4][5]. Without discounting the diagnostic quandary it poses in resource-rich settings, the challenge is even greater in developing countries with limited diagnostic capabilities and a higher proportion of HIV-positive individuals presenting to care with advanced HIV disease, which is among the causes of a negative HIV serology [4]. Lack of guidance for the diagnosis of seronegative HIV, especially in developing countries, leads to a majority of these people losing their lives while seeking medical help for an unidentifiable illness, paucity of data, and underreporting of the true prevalence.…”

mentioning

confidence: 99%

“…Apart from advanced HIV disease [4], other reported reasons for a negative HIV antibody test in an HIVpositive individual include: non-adherence to WHO testing guidelines; retesting among known people living with HIV on antiretroviral therapy (ART); and testing during the window period or early stage of infection where the HIV antibody response has not yet developed [2,5]. Moreover, a recent meta-analysis found initiation of combined ART within the early/acute period of HIV infection in adults or before the age of 6 months in children, to be associated with a greater likelihood of a negative antibody test later on [6].…”

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confidence: 99%

Sero‐negative HIV, a need for presumptive HIV diagnosis in adults in developing countries

Ndege

2023

HIV Medicine

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Pneumocystis Pneumonia misdiagnosed as Pulmonary Tuberculosis in a patient with repeatedly false-negative HIV tests

Bodoarcă,

Tabacu

et al. 2023

Pneumologia

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Pneumocystis jirovecii pneumonia, previously known as Pneumocystis carinii Pneumonia (PCP), is a fungal infection most commonly encountered in immunocompromised patients and, in some cases, can be life-threatening. Patients at risk include those with cancer, HIV positive, transplant recipients, and those under immunosuppressive therapies. There are no specific signs or symptoms for PCP and its differential diagnosis includes other viral or bacterial pneumonias and also Tuberculosis, the latter especially in high endemic areas. We present the case of a 32 year-old female patient who presented to the hospital for dyspnea and cough, treated for Pulmonary Tuberculosis, and eventually diagnosed with Pneumocystis Pneumonia, in spite of her multiple false-negative HIV tests.

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Repeated false-negative HIV rapid test results in a patient presenting to care with advanced HIV disease: A case report

Cited by 3 publications

References 7 publications

Diagnostic challenge of Pneumocystis jirovecii pneumonia infection mimicking interstitial lung disease in initially HIV negative patient

Diagnostic challenge of Pneumocystis jirovecii pneumonia infection mimicking interstitial lung disease in initially HIV negative patient

Sero‐negative HIV, a need for presumptive HIV diagnosis in adults in developing countries

Pneumocystis Pneumonia misdiagnosed as Pulmonary Tuberculosis in a patient with repeatedly false-negative HIV tests

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