False Positive Tests for HIV in a Woman with Lupus and Renal Failure

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Abstract
We recently encountered the uncommon situation of a false positive test for human immunodeficiency virus type 1 (HIV-1) during the pretransplantation evaluation of a 32-year-old Haitian woman with systemic lupus erythematosus and end-stage renal disease. Her condition had been stable with the use of hemodialysis for the previous 6 years, and she had resided in the United States for 15 years. Serologic tests were negative for cytomegalovirus, Epstein-Barr virus, herpes, toxoplasmosis, and hepatitis. Screening tests for syphilis were also negative. Both she and her husband were monogamous, with no history of drug abuse or blood transfusions. She did not have any AIDS-defining illnesses. Screening for HIV-1 showed strongly seropositive results by enzyme-linked immunosorbent assay (ELISA), which was performed three times at six-week intervals, and by Western blotting for the following antibodies: p17, p24, p31, gp41, p51, p55, p66, gp120, and gp160. The patient's absolute CD4+ counts were 130 per cubic millimeter; the total T-cell and CD8 counts were normal. She vehemently denied any risk factors for HIV infection and had heard at a lupus support group that she could test positive for HIV-1 as a result of a “universal antibody.” Since she very much wanted a renal transplant, we extended the evaluation to include p24 antigen testing, the polymerase chain reaction (PCR) (performed at the New York Blood Center), and viral culture (done at Mount Sinai Medical Center, New York), all of which were negative. We speculate that the false positive test may have been due to the presence of autoantibodies related to the systemic lupus erythematosus. The patient is now on the waiting list for a kidney transplant.

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