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). Current guidelines for diagnosing HIV infection in Mexico require a confirmatory Western blot (WB) after a positive ELISA test.
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