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The HIV antibody testing strategy routinely used in the U.S. has excellent performance characteristics, with sensitivity and specificity reliably exceeding 99%. Still, HIV-infected people sometimes test negative. Many of these false-negative results reflect testing during the “window” period of infection or infection with either HIV-2 or non-clade B virus. Occasionally, however, patients are repeatedly seronegative despite massive viremia and all the usual clinical manifestations of AIDS.
Reviewers found 25 such cases in the literature since 1994, in patients aged 2 months to 59 years. All of the patients presented with clinical AIDS; CD4 counts ranged from 0 to 230 cells/mm3. Viral loads (reported for 18 patients) ranged from 20,000 to >8 m…