Early identification of seronegative human immunodeficiency virus type 1 infection with severe presentation.

Specific antibodies against human immunodeficiency virus (HIV), usually used for diagnosis, almost invariably become detectable within 3 months of exposure. We report on a patient whose HIV infection was identified early by a combined antigen/antibody test, but seroconversion did not occur for 7 months, until the implementation of antiretroviral therapy.

Post-evaluation of rapid HIV kits in the Korean market by an anti-HIV EQAS panel.

This study aimed to provide evaluation information about rapid HIV kits by the anti-HIV External Quality Assessment Schemes (EQAS) panel of the Korea National Institute of Health (KNIH) and the rapid HIV test panel of the US Centers for Disease Control and Prevention (CDC). Each KNIH anti-HIV EQAS panel from 2003 to 2005 consisted of four or five samples of plasma obtained from blood donors with a strong positive or negative reaction to HIV. KNIH delivered each panel to public health centers for analysis of the HIV test results, and the reactivity of the five rapid HIV kits currently used in the Korean market were compared with that of a CDC reference. The analytic sensitivity and specificity of the rapid HIV kits for the KNIH anti-HIV EQAS in 2005 were 99.3 and 99.1%, respectively; in 2004, 98.8 and 97.1%; and in 2003, 94.8 and 95.9%. Five HIV kits from the CDC panel consistently showed positive reactivity for strong positive samples in all kits, but some showed erratic reactivity for weakly positive samples. This is the first report on post-evaluation of rapid HIV kits in the Korean market by an anti-HIV EQAS panel. It was found that the quality of performance of the rapid HIV tests had improved each year but should be interpreted with caution for weakly positive samples.

Inverse relationship between viral load and genotypic resistance mutations in Korean patients with primary HIV type 1 infections.

The transmission of antiretroviral-resistant HIV-1 strains is associated with suboptimal virological responses to initial antiretroviral therapy. However, certain types of resistance mutations are known to be associated with decreased viral fitness, which confers a lower replication capacity than that of the wild-type virus in the absence of antiretroviral drugs. Therefore, we evaluated the relationship between antiretroviral resistance mutations and viral replication in the primary HIV-1 infection (PHI) period. From January 2002 to March 2005, 52 PHI patients were identified in the Republic of Korea. HIV-1 RNA genotyping was performed, and the resistance mutation score was obtained from the HIV Drug Resistance Database of Stanford University. We defined the sum of the average resistance mutation scores (SARMS) for each antiretroviral drug class as a measure of the degree of resistance of any specific strain. The overall mean SARMS was 2.00 +/- 2.74, and the annual mean did not change significantly during the study period. No critical resistance mutation gene was identified in the study group. The SARMS showed a weak negative correlation with the viral load log10 during PHI, but without statistical significance (r = -0.274, p = 0.051). But the mean SARMS of patients with a viral load exceeding 100,000 copies/ml was significantly lower than that of patients with a viral load of less than 100,000 copies/ml (p = 0.03). Evaluation of the potency of antiretroviral resistance revealed a weak negative correlation with viral replication in the PHI period. This could be one reason why the transmission of resistant strains in PHI patients is not increasing significantly despite the widespread use of highly active antiretroviral therapy (HAART).

Seroprevalence of sexually transmitted viruses in Korean populations including HIV-seropositive individuals.

In order to investigate the prevalence of sexually transmitted viruses (STVs) in Korean populations, the prevalence of specific antibodies to herpes simplex type 2 (HSV-2) and hepatitis C virus (HCV) and surface antigen to hepatitis B virus (HBsAg) was evaluated in blood donors (n = 200), voluntary visitors for STI testing in public health centre (n = 204), HIV seropositive individuals (n = 200) and commercial sex workers (CSWs) (n = 200). All blood samples were tested using commercial enzyme-linked immunosorbent assay (ELISA) kits that detect type-specific IgG to HSV-2 and HBsAg and anti-HCV. The prevalence of type-specific IgG to HSV-2 among the above four groups was 5.0%, 21.9%, 65.0% and 71.0%, respectively. The seroprevalence of HBsAg was 0% in blood donors, 7.0% of visitors for STI, 7.5% of HIV infected individuals and 1.2% in CSWs. That of anti-HCV was 0%, 2.5%, 5.0% and 10.3%, respectively. This study underlines the very high seroprevalence of STVs, especially HSV-2, in the group at high risk of STI. The prevalences of HCV in CSWs and HIV infected individuals were two to three times higher than STI patients. It means sexual transmission might be a possible route of transmission of HCV, because HIV infection is closely related with sexual behaviour in Korea. The spread of HSV-2 is dependent on sexual transmission and that the presence of antibody to HSV-2 may be suitable for use as a serological marker of the degree at risk of STI.