In doubt, the patient returned to the laboratory where he first tested positive, and a new test reported reactive again. The next day, he asked for primary care consultation and underwent another rapid 3rd Gen-test, reported non-reactive. After this result, delivered without counseling, he requested further HIV testing in three different places the same day: 1) Public Health Care Provider in a primary care setting, where a 3rd Gen-rapid test reported non-reactive, 2) Public AIDS-Counseling Center where a 3rd Gen- rapid test reported non-reactive, and 3) an AIDS-NGO facility where two rapid tests (Genie-Fast HIV1/2 3rd- and ALERE HIV-Combo, 4th-Gen) were performed simultaneously, and both reported non-reactive. A 4th Gen chemiluminescence HIV-test was performed and reported reactive. Fearing an HIV-infection because of a previous history of risk behavior, the patient sought laboratory-based testing. Seven days after the beginning of symptoms, fever subdued, but malaise remained. Total cholesterol 105 mg/dL, alanine aminotransferase 134 UI/L, aspartate aminotransferase 190 UI/L, and lactate dehydrogenase 307 UI/L. He had had a rapid HIV test two months before the onset of symptoms, which was negative. Unsolicited and unsupervised laboratory tests were performed, including a rapid HIV-antibody test which was reported as non-reactive. The patient remained febrile and weak for the next five days. The physician confirmed pharyngitis, endorsed symptomatic treatment but withdrew antibiotics. The next day he developed 38.5 ☌ fever with intense diaphoresis and consulted with another general practitioner. He was diagnosed with pharyngitis and prescribed antibiotics and paracetamol. Here, we present an illustrative case of a near-misdiagnosis in a patient in early seroconversion who endured several rapid and laboratory-based ELISA HIV-testing with discordant results and referred to our laboratory for WB-testing.Ī 29-year-old male presented to a general practitioner with pain in the left arm and legs, weakness, sore throat, and chills. Additionally, it is suggested that in LMIC, appropriate testing strategies should be established for the diagnosis of acute HIV infection (AHI), for which explicit diagnostic algorithms, point of care testing, and clinical risk-scores may be critical. Despite great advances in diagnosis by the use of RT and availability of therapy, in many low and middle-income countries (LMIC), significant misdiagnosis causes remain, such as performance of suboptimal testing algorithms, poor diagnosis delivery, inadequate initial assessment, and error interpreting results. It is estimated that in 2018 nearly 85 % of people in eastern and southern Africa and 80 % of people with HIV worldwide knew their status. The World Health Organization (WHO) recommended abandoning WB use in favor of EIA and rapid tests (RT) to achieve the goals of an accurate and reliable diagnosis globally, providing comprehensive HIV-testing services to increase the number of people aware of their infection status. This situation may lead to patients' misdiagnosis in the early seroconversion period, where antibodies are not detected by WB. However, health care providers who still follow guidelines based on ELISA/WB scheme may not consider a reactive 4th Gen EIA/ELISA to be true positive unless confirmatory WB is also positive. The diagnostic algorithm introduced by CDC in 2014 recommends the fourth-generation HIV-EIA test (4th Gen), which detects both antibodies and p24 antigen and reduces WP to two weeks after infection. Serological detection of anti-HIV antibodies during acute infection takes three to six weeks after infection due to the window period (WP). The pattern of staining on the two blots (HSV-1 and HSV-2) is dictated by the number and identity of the HSV proteins to which the patient's immune system has antibody.Current guidelines for diagnosing HIV infection in Mexico require a confirmatory Western blot (WB) after a positive ELISA test. Antibodies, which bind to the viral proteins, are detected by an enzyme-mediated color change. The strips of paper or 'blots' containing separated fixed proteins from either HSV-1 or HSV-2 are incubated with the patient's serum. HSV1 and HSV2 proteins from detergent lysates ('Bernstein's lysate') of HSV infected cells are separated by electrophoresis and transferred to nitrocellulose paper. For accurate seroconversion determination, the acute and convalescent samples should be drawn at least 12 -16 weeks apart. The detection of HSV1 and HSV2 IgG class antibodies by Western blot in acute and convalescent serum.

Indeterminate western blot