False‐positive human immunodeficiency virus type 1 western blot tests in noninfected blood donors

False‐positive human immunodeficiency virus type 1 western blot tests in noninfected blood donors Background: The manufacturers' criteria for a positive human immunodeficiency virus type 1 (HIV‐1) Western blot (WB) test were recently revised to require reactivity to only two of the following bands: p24, gp41, and gp120/160. In a recent report, low‐risk blood donors were identified in whom nonspecific reactivity to multiple env antigens in WB testing resulted in apparently false‐positive WBs by these criteria. The present study was conducted to verify the existence of false‐positive WBs among noninfected donors and to assess the extent of this problem. Study Design and Methods: Four donors classified as WB‐ positive on the basis of env‐only (3 cases) or p24/env‐only (1 case) patterns were investigated. Index and/or follow‐up specimens were tested by polymerase chain reaction (PCR), by overlapping recombinant env antigens and synthetic peptides in enzyme immunoassays, and by deglycosylated and denatured antigen WBs. WB records from American Red Cross blood centers were reviewed to determine the frequency of env‐ only and p24/env‐only patterns, relative to all positive WBs, from 1988 through 1993. Results: The four index‐case donors denied risk and had stable WB reactivity during follow‐up. HIV PCR was negative in all. Env reactivity was restricted to nonglycosylated gp41 epitopes; no gp120‐ specific reactivity was detected. For three of the four donors, env reactivity was mapped to a 20‐amino acid N‐terminal epitope of gp41. The rate of detecting WBs with these false‐positive patterns increased from 0.6 percent of all positive WBs from 1988 to 1990 (4/776) to 8 percent in 1991 and 1992 (52/683), and then it declined to 6 percent in 1992 and 1993 (47/783). Env‐only patterns predominated in 1991 and 1992, whereas p24/env‐only patterns were more frequent following implementation of combined anti‐HIV‐1/HIV type 2 enzyme immunoassays in 1992. Conclusion: Low‐risk blood donors can have false‐positive results on WB tests. Increased detection of env‐only and p24/env‐only WBs appears related to the enhanced sensitivity of newer enzyme immunoassays to gp41 and p24 antibodies. Donors with these patterns should undergo follow‐up testing to document the presence or absence of HIV infection. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Transfusion Wiley

False‐positive human immunodeficiency virus type 1 western blot tests in noninfected blood donors

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Publisher
Wiley
Copyright
1996 AABB
ISSN
0041-1132
eISSN
1537-2995
DOI
10.1046/j.1537-2995.1996.36196190514.x
Publisher site
See Article on Publisher Site

Abstract

Background: The manufacturers' criteria for a positive human immunodeficiency virus type 1 (HIV‐1) Western blot (WB) test were recently revised to require reactivity to only two of the following bands: p24, gp41, and gp120/160. In a recent report, low‐risk blood donors were identified in whom nonspecific reactivity to multiple env antigens in WB testing resulted in apparently false‐positive WBs by these criteria. The present study was conducted to verify the existence of false‐positive WBs among noninfected donors and to assess the extent of this problem. Study Design and Methods: Four donors classified as WB‐ positive on the basis of env‐only (3 cases) or p24/env‐only (1 case) patterns were investigated. Index and/or follow‐up specimens were tested by polymerase chain reaction (PCR), by overlapping recombinant env antigens and synthetic peptides in enzyme immunoassays, and by deglycosylated and denatured antigen WBs. WB records from American Red Cross blood centers were reviewed to determine the frequency of env‐ only and p24/env‐only patterns, relative to all positive WBs, from 1988 through 1993. Results: The four index‐case donors denied risk and had stable WB reactivity during follow‐up. HIV PCR was negative in all. Env reactivity was restricted to nonglycosylated gp41 epitopes; no gp120‐ specific reactivity was detected. For three of the four donors, env reactivity was mapped to a 20‐amino acid N‐terminal epitope of gp41. The rate of detecting WBs with these false‐positive patterns increased from 0.6 percent of all positive WBs from 1988 to 1990 (4/776) to 8 percent in 1991 and 1992 (52/683), and then it declined to 6 percent in 1992 and 1993 (47/783). Env‐only patterns predominated in 1991 and 1992, whereas p24/env‐only patterns were more frequent following implementation of combined anti‐HIV‐1/HIV type 2 enzyme immunoassays in 1992. Conclusion: Low‐risk blood donors can have false‐positive results on WB tests. Increased detection of env‐only and p24/env‐only WBs appears related to the enhanced sensitivity of newer enzyme immunoassays to gp41 and p24 antibodies. Donors with these patterns should undergo follow‐up testing to document the presence or absence of HIV infection.

Journal

TransfusionWiley

Published: Jan 1, 1996

References

  • Evaluation of atypical human immunodeficiency virus immunoblot reactivity in blood donors
    Dock, Dock; Lamberson, Lamberson; O'Brien, O'Brien
  • Resolution of infection status of human immunodeficiency virus (HIV)‐seroindeterminate and high‐risk seronegative individuals with polymerase chain reaction and virus culture: absence of persistent silent HIV type 1 infection in a high‐prevalence area
    Eble, Eble; Busch, Busch; Khayam‐Bashi, Khayam‐Bashi
  • Reliable confirmation and quantitation of human immunodeficiency virus type 1 antibody using a recombinant‐antigen immunoblot assay
    Busch, Busch; El Amad, El Amad; McHugh, McHugh

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