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Most new HIV infections are easily diagnosed using the standard algorithms. A few, however, are difficult to pin down, possibly reflecting an early natural viral suppression that may ultimately turn into elite control.
Young black male participants in a longitudinal HIV prevention study were HIV tested at enrollment and then 6 and 12 months later; serum samples were stored and subsequently retested with a large battery of diagnostic antigen and antibody assays. All told, 28 of the 1164 participants acquired HIV during the study. In 22, the diagnosis was straightforward, but the remaining 6 had unusual patterns. Four had positive results on standard serologic tests, including the Western blot, but unusually low viral loads (range, 82–837 copi…