Risk factors for repeatedly reactive HIV-1 EIA and indeterminate western blots. A population-based case-control study.

OBJECTIVE Causes of indeterminate results of Western blot testing (IWB) for human immunodeficiency virus (HIV) type 1 include seroconversion, HIV-2 cross-reactivity, and autoimmune disease, but most IWB results remain unexplained. This case-control study assessed risk factors for IWB results, including early HIV infection, other retroviral infection, autoantibodies, and other medical conditions. DESIGN Prospective study to determine HIV seroconversion rate, with a case-control design to assess other risk factors for IWB. Cases (persons with one or more repeatedly reactive HIV-1 enzyme immunoassay with IWB), their current sexual partners, and controls (persons with negative enzyme immunoassay and Western blot results) were recruited from blood banks, health department and prenatal clinics, and private providers in Washington and Oregon. RESULTS Of 244 cases enrolled, 206 were followed up for 6 months or longer, and six (3.0%; 95% confidence interval [CI], 0.7% to 5.3%) with recent HIV risk behaviors seroconverted. The Western blot banding patterns differed among groups; cases usually had p17 or p24 bands, while controls and cases' sexual partners usually had polymerase bands. Conditional logistic regression indicated that independent risk factors for IWB among male cases and controls were a tetanus booster in the past 2 years (odds ratio, 3.2; 95% CI, 1.2 to 8.6) and sexual contact with a prostitute (odds ratio, 3.0; 95% CI, 1.0 to 9.5). Independent risk factors for women were parity (odds ratio, 1.2; 95% CI, 1.02 to 1.4) and autoantibodies, either rheumatoid factor or antinuclear antibodies (odds ratio, 2.3; 95% CI, 1.03 to 5.6). No cross-reactivity was detected with HIV-2, human T-lymphotrophic virus type 1, feline immunodeficiency or feline leukemia, or bovine immunodeficiency viruses. CONCLUSIONS Evaluation of persons with reactive HIV-1 enzyme immunoassays and IWB should include an assessment of HIV risk and other possible risk factors, such as alloimmunization (ie, parity or recent immunization) or autoantibodies (ie, antinuclear antibodies and rheumatoid factor). The relationship of IWB among men who reported sex with prostitutes is intriguing and warrants further study.

[1]  J. Hsia.  False-positive ELISA for human immunodeficiency virus after influenza vaccination. , 1993, Journal of Infectious Diseases.

[2]  R. Coombs,et al.  Indeterminate HIV-1 western blots , 1992, Journal of general internal medicine.

[3]  J. Catania,et al.  Prevalence and correlates of herpes simplex infections. The population-based AIDS in Multiethnic Neighborhoods Study. , 1992 .

[4]  W. M. Mac Kenzie,et al.  Multiple false-positive serologic tests for HIV, HTLV-1, and hepatitis C following influenza vaccination, 1991. , 1992, JAMA.

[5]  Lawrence Corey,et al.  Underdiagnosis of Genital Herpes by Current Clinical and Viral-Isolation Procedures , 1992 .

[6]  T. O'Brien,et al.  Human immunodeficiency virus type 2 infection in the United States. Epidemiology, diagnosis, and public health implications. , 1992, JAMA.

[7]  Myers Ra,et al.  Identifying HIV-2-seropositive individuals by reevaluating HIV-1 indeterminate sera , 1992 .

[8]  K. Holmes,et al.  Indeterminate human immunodeficiency virus type 1 western blots: seroconversion risk, specificity of supplemental tests, and an algorithm for evaluation. , 1991, The Journal of infectious diseases.

[9]  M. Lafontaine,et al.  Cross-reactivity on western blots in HIV-1 and HIV-2 infections. , 1991, AIDS.

[10]  S. Kleinman,et al.  Human immunodeficiency virus infection and indeterminate western blot patterns. Prospective studies in a low prevalence population. , 1991, Archives of internal medicine.

[11]  J. Drabick,et al.  Absence of retroviral sequences in Graves' disease , 1991, The Lancet.

[12]  H. Farzadegan,et al.  Frequency of indeterminate western blot tests in healthy adults at low risk for human immunodeficiency virus infection. The NIAID AIDS Vaccine Clinical Trails Network. , 1990, The Journal of infectious diseases.

[13]  L. Donehower,et al.  Detection of a human intracisternal A-type retroviral particle antigenically related to HIV. , 1990, Science.

[14]  M. Takei,et al.  A conserved idiotype and antibodies to retroviral proteins in systemic lupus erythematosus. , 1990, The Journal of clinical investigation.

[15]  D. Hart,et al.  Detection of serum antibodies to retroviral proteins in patients with primary Sjögren's syndrome (autoimmune exocrinopathy). , 1990, Arthritis and rheumatism.

[16]  K. D. de Cock,et al.  Efficacies of US Food and Drug Administration-licensed HIV-1-screening enzyme immunoassays for detecting antibodies to HIV-2. , 1990, AIDS.

[17]  R. Belshe,et al.  Characteristics of a Population Volunteering for Human Immunodeficiency Virus Immunization , 1990, International journal of STD & AIDS.

[18]  J. Sninsky,et al.  Absence of HIV infection in blood donors with indeterminate western blot tests for antibody to HIV-1. , 1990, The New England journal of medicine.

[19]  C. K. Grant,et al.  Feline immunodeficiency virus and feline leukemia virus infections and their relationships to lymphoid malignancies in cats: a retrospective study (1968-1988). , 1990, Journal of acquired immune deficiency syndromes.

[20]  Update: serologic testing for HIV-1 antibody--United States, 1988 and 1989. , 1990, MMWR. Morbidity and mortality weekly report.

[21]  A. Couroucé.  FOLLOWING UP INDETERMINATE HIV-1 WESTERN BLOTS , 1989, The Lancet.

[22]  M. Chiasson,et al.  Update: HIV-2 infection--United States. , 1989, MMWR. Morbidity and mortality weekly report.

[23]  J. Ward,et al.  DURATION OF HUMAN IMMUNODEFICIENCY VIRUS INFECTION BEFORE DETECTION OF ANTIBODY , 1989, The Lancet.

[24]  R. Valdiserri,et al.  Interpretation and Use of the Western Blot Assay for Serodiagnosis of Human Immunodeficiency Virus Type 1 Infections , 1989, Infection Control & Hospital Epidemiology.

[25]  L. Magder,et al.  A seroepidemiologic survey of the prevalence of herpes simplex virus type 2 infection in the United States. , 1989, The New England journal of medicine.

[26]  R. Pujol-Borrell,et al.  RETROVIRUS-LIKE SEQUENCES IN GRAVES' DISEASE: IMPLICATIONS FOR HUMAN AUTOIMMUNITY , 1989, The Lancet.

[27]  D. Maki,et al.  The case for wider use of testing for HIV infection. , 1989, The New England journal of medicine.

[28]  H. Balfour,et al.  Performance characteristics of serologic tests for human immunodeficiency virus type 1 (HIV-1) antibody among Minnesota blood donors. Public health and clinical implications. , 1989, Annals of internal medicine.

[29]  R. Redfield,et al.  Measurement of the false positive rate in a screening program for human immunodeficiency virus infections. , 1988, The New England journal of medicine.

[30]  D. Tribe,et al.  Evaluation of atypical human immunodeficiency virus immunoblot reactivity in blood donors , 1988, Transfusion.

[31]  J. Phair,et al.  Loss of human immunodeficiency virus type 1 (HIV-1) antibodies with evidence of viral infection in asymptomatic homosexual men. A report from the Multicenter AIDS Cohort Study. , 1988, Annals of internal medicine.

[32]  S. Kleinman,et al.  Follow‐up testing and notification of anti‐HIV Western blot atypical (indeterminant) donors , 1988, Transfusion.

[33]  P E Dans,et al.  Human immunodeficiency virus test evaluation, performance, and use. Proposals to make good tests better. , 1988, JAMA.

[34]  R L Ashley,et al.  Comparison of Western blot (immunoblot) and glycoprotein G-specific immunodot enzyme assay for detecting antibodies to herpes simplex virus types 1 and 2 in human sera , 1988, Journal of clinical microbiology.

[35]  A. Ranki,et al.  Interpretation of antibodies reacting solely with human retroviral core proteins. , 1988, The New England journal of medicine.

[36]  M. Leuther,et al.  LONG LATENCY PRECEDES OVERT SEROCONVERSION IN SEXUALLY TRANSMITTED HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION , 1987, The Lancet.

[37]  J. Albert,et al.  ANTIBODY RESPONSE IN PRIMARY HUMAN IMMUNODEFICIENCY VIRUS INFECTION , 1987, The Lancet.

[38]  J Desmyter,et al.  EVALUATION OF SIX ENZYME IMMUNOASSAYS FOR ANTIBODY AGAINST HUMAN IMMUNODEFICIENCY VIRUS , 1986, The Lancet.

[39]  A J Grindon,et al.  Laboratory and epidemiologic evaluation of an enzyme immunoassay for antibodies to HTLV-III. , 1986, JAMA.

[40]  S. Alexander,et al.  HTLV-III seropositivity in 1971-1972 parenteral drug abusers--a case of false positives or evidence of viral exposure? , 1986, The New England journal of medicine.

[41]  G. Roselle,et al.  False positive tests for HTLV-III antibodies in alcoholic patients with hepatitis. , 1986, The New England journal of medicine.

[42]  J. Hansen,et al.  HLA antibodies as a cause of false‐positive reactions in screening enzyme immunoassays for antibodies to human T‐lymphotropic virus Type III , 1986, Transfusion.

[43]  J. Nielsen,et al.  Variation in human T lymphotropic virus III (HTLV-III) antibodies in homosexual men: decline before onset of illness related to acquired immune deficiency syndrome (AIDS). , 1985, British medical journal.

[44]  M B Gardner,et al.  AIDS serology testing in low- and high-risk groups. , 1985, JAMA.

[45]  P. Kühnl,et al.  HLA DR4 ANTIBODIES CAUSE POSITIVE HTLV-III ANTIBODY ELISA RESULTS , 1985, The Lancet.

[46]  N. LaRusso,et al.  Rapid dissolution of gallstones by methyl tert-butyl ether. Preliminary observations. , 1985, The New England journal of medicine.