Continuing Medical Education

False-negative HIV-1 polymerase chain reaction in a 15-month-old boy with HIV-1 subtype C infection

Regina Oladokun, Stephen Korsman, Nonkululeko Ndabambi, Nei-yuan Hsiao, Lucia Hans, Carolyn Williamson, Melissa-Rose Abrahams, Brian Eley

Abstract


Polymerase chain reaction (PCR) testing is the gold standard for determining the HIV status in children <18 months of age. However, when clinical
manifestations are not consistent with laboratory results, additional investigation is required. We report a 15-month-old HIV-exposed boy referred
to our hospital after he had been admitted several times for infectious diseases. A rapid antibody test on the child was positive, while routine
diagnostic HIV PCRs using the Roche COBAS Ampliprep/COBAS TaqMan HIV Qual Test were negative at 6 weeks, 6 months, 7 months and
15 months. In addition, the same PCR test performed on the HIV-infected mother was also negative. Alternative PCR and viral load assays using
different primer sets detected HIV RNA or proviral DNA in both child and mother. Gag sequences from the child and his mother classified both
infections as HIV-1 subtype C, with very rare mutations that may have resulted in PCR assay primer/probe mismatch. Consequently, the child was
commenced on antiretroviral therapy and made a remarkable recovery. These findings indicate that more reliable PCR assays capable of detecting
a wide range of HIV subtypes are desirable to circumvent the clinical problems created by false-negative PCR results.


Authors' affiliations

Regina Oladokun, Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Department of Paediatrics and Child Health, University of Cape Town, South Africa

Stephen Korsman, Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa

Nonkululeko Ndabambi, Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, South Africa

Nei-yuan Hsiao, Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa

Lucia Hans, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa

Carolyn Williamson, Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa

Melissa-Rose Abrahams, Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, South Africa

Brian Eley, Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Department of Paediatrics and Child Health, University of Cape Town, South Africa

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Keywords

HIV; Infant diagnosis; Sensitivity; PCR

Cite this article

South African Medical Journal 2015;105(10):877. DOI:10.7196/SAMJnew.8787

Article History

Date submitted: 2015-09-21
Date published: 2015-09-21

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