Human immunodeficiency virus testing pitfalls and clinical suspicion

Kazuaki Jindai, Bethaney Kunzer, Tam T. Van, Rob Striker

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Universal human immunodeficiency virus (HIV) screening was recommended in 2012, and major improvements in HIV testing have occurred in the past decade, but identification of HIV infected individuals remains inadequate in the United States. We report the case of a seronegative HIV-infected man who despite clinical and laboratory findings of acquired immunodeficiency syndrome, repeatedly tested nonreactive to third-generation HIV enzyme immunoassays (EIAs) and Western blot testing. Serologic diagnosis in this case required fourth-generation EIA testing due to the seronegativity of standard testing. The fourth-generation HIV EIA was positive presumably because it detects p24 HIV antigen as well as antibodies, unlike rapid HIV tests and third-generation HIV EIAs. This case highlights not only the importance of frontline providers to understand the different testingmethodologies for HIV screening and their limitations but the importance of clinical suspicion as well.

Original languageEnglish
Pages (from-to)1442.e1-1442.e2
JournalAmerican Journal of Emergency Medicine
Issue number11
Publication statusPublished - 2014 Nov 1
Externally publishedYes

ASJC Scopus subject areas

  • Emergency Medicine


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