Journal of Global Infectious Diseases

LETTER TO EDITOR
Year
: 2022  |  Volume : 14  |  Issue : 1  |  Page : 43--44

False-positive human immunodeficiency virus reactivity in COVID patients: A word of caution


Smriti Srivastava1, Parul Singh1, Rajesh Malhotra2, Purva Mathur1,  
1 Department of Microbiology, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
2 Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Prof. Purva Mathur
Department of Microbiology, 3rd Floor, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi - 110 029
India




How to cite this article:
Srivastava S, Singh P, Malhotra R, Mathur P. False-positive human immunodeficiency virus reactivity in COVID patients: A word of caution.J Global Infect Dis 2022;14:43-44


How to cite this URL:
Srivastava S, Singh P, Malhotra R, Mathur P. False-positive human immunodeficiency virus reactivity in COVID patients: A word of caution. J Global Infect Dis [serial online] 2022 [cited 2022 Jul 2 ];14:43-44
Available from: https://www.jgid.org/text.asp?2022/14/1/43/338616


Full Text



Sir,

Human immunodeficiency virus (HIV) testing as a part of screening is accomplished by TRI-DOT Rapid HIV flow-through test (DIAGNOSTIC ENTERPRISES, H.P, India) and VIDAS® HIV DUO ULTRA, 4th generation assay (BioMérieux, Marcy-l'Etoile, France) at the Serology Laboratory of our center. We report two patients from the intensive care unit admitted at our dedicated COVID center who falsely reacted to HIV-1/2 by the VIDAS® HIV panel.

In the first case, a 69-year-old male was admitted with COVID-19 associated respiratory distress on April 16, 2021. The patient developed COVID ARDS, sepsis, and acute kidney injury. He succumbed to cardiac arrest on day 23. Viral markers for HIV, HBsAg, and HCV were requested on day 14.

We noted that TRI-DOT was nonreactive, whereas VIDAS was reactive with 2.48 s/CO ratio for anti-HIV ½, antigen (p24) was not detected by VIDAS (A signal/cutoff ratio of ≥0.25 is considered reactive). He tested nonreactive for HBsAg (VIDAS®) and HCV (HCV TRI-DOT). COVID antibodies using VIDAS® severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) IgG and IgM were found 0.87 (s/CO) for IgM and 15.50 for IgG. (s/CO values of ≥1 are considered reactive).

A repeat sample on day 17 gave similar results. (TRI-DOT being nonreactive and VIDAS being reactive with 2.91 s/CO ratio for anti-HIV ½). Part of the sample was tested on Abbott Architect platform (Abbott Laboratories, Abbott Park, Illinois, USA) and found reactive with 1.2 s/CO ratio (s/CO values of ≥1 are considered reactive).

The second case was a 9-year-old boy admitted on May 7, 2021, with seizure, and dehydration and diagnosed with COVID by reverse transcription-polymerase chain reaction. Viral markers for HIV, HBsAg, and HCV were requested on day 12 of admission.

We found TRI-DOT nonreactive and VIDAS reactive with 1.22 s/CO ratio for anti-HIV ½. However, antigen (p24) was again not detected. He tested nonreactive for HBsAg (VIDAS®) and HCV (HCV TRI-DOT).

With repeat sample on day 14, TRI-DOT gave a nonreactive result, and VIDAS® HIV was reactive with a s/CO ratio of 0.89. Part of the sample tested on Abbott Architect platform was found nonreactive. COVID antibodies detected by VIDAS® SARS COV-2 IgG and IgM were 0.27 (s/CO) for IgM and 7.20 for IgG.

The clinical and laboratory parameters of both patients are given in [Table 1].{Table 1}

Conclusively, low titers of antibodies are expected in recent HIV infection, very advanced disease, and presence of broadly cross-reacting antibodies. Advanced disease was ruled out on the basis of presenting illnesses, whereas in early HIV infection, the presence of antigen is expected. This leaves us with the cross-reacting antibodies. False-positive reactions with other 4th generation assays have been seen with schistosomiasis, Epstein–Barr virus, and malignancy.[1],[2],[3] During the current pandemic, Tan et al. also reported two COVID patients who had falsely tested reactive to HIV, on Abbott Architect, whereas VIDAS® HIV and MP Biomedicals HIV immunoblot were negative.[4] The coronavirus spike proteins and envelope glycoproteins of HIV are structurally homologous, extensively glycosylated class 1 type fusion proteins,[5] and some incidents of cross reactivity are expected with an ongoing pandemic.

Acknowledgment

We are thankful to our nursing staff, laboratory staff, and fellow doctors for their cooperation and support.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Everett DB, Baisely KJ, McNerney R, Hambleton I, Chirwa T, Ross DA, et al. Association of schistosomiasis with false-positive HIV test results in an African adolescent population. J Clin Microbiol 2010;48:1570-7.
2Reid J, Van Zyl G, Linström M, Korsman S, Marais G, Preiser W. High positive HIV serology results can still be false positive. IDCases 2020;21:e00849.
3Liu P, Jackson P, Shaw N, Heysell S. Spectrum of false positivity for the fourth generation human immunodeficiency virus diagnostic tests. AIDS Res Ther 2016;13:1.
4Tan SS, Chew KL, Saw S, Jureen R, Sethi S. Cross-reactivity of SARS-CoV-2 with HIV chemiluminescent assay leading to false-positive results. J Clin Pathol 2021;74:614.
5Rey FA, Lok SM. Common features of enveloped viruses and implications for immunogen design for next-generation vaccines. Cell 2018;172:1319-34.