ficiency syndrome (AIDS) occurs. Once seroconversion Over a period of 3 months a human immunodefitakes place, anti-HIV EIAs are considered to yield a ciency virus 1 (HIV-1)-infected patient showed a positive result throughout the remaining life span of sequence of positive-negative-positive anti-HIV the patient. Some HIV-1-infected patients have been screening test results. During this period the level described in whom anti-HIV EIAs were persistently of HIV p24 antigen declined and the HIV antibody negative [U.S. Department of Health and Human Serpattern by Western blot gradually became comvices, 1996; Martin-Rico et al., 1995; Soriano et al., plete, suggesting recent HIV infection. However 1994]. We now describe an HIV-1-infected patient the patient's weight loss, esophageal candidiashowing transient anti-HIV seronegativity. sis, and Pneumocystis carinii pneumonia, together with the severely and persistently lowered CLINICAL FINDINGS AND TEST RESULTS
CD4 cell counts and the absence of an IgM anti-
A Dutch patient (male, age 43) visited his physician HIV response, suggest late-stage HIV infection.
because of malaise, fever, and weight loss of approxi-Despite additional and follow-up testing, it was mately 15 kg during the last 3 weeks. Physical examinaimpossible to determine whether the patient suftion revealed lymphadenopathy in the neck and esophafered from acute, primary HIV infection with segeal candidiasis, which was treated successfully with vere immunodepression or from advanced HIV fluconazole. The local laboratory found a third-generainfection (AIDS) with hampered HIV antibody tion EIA for HIV antibodies (HIV-1/2 3rd generation production leading to false-negative test results plus, Abbott Laboratories, Delkenheim, Germany) to by the anti-HIV enzyme immunoassay and Westbe reactive and submitted a sample for confirmatory ern blot. This case illustrates that HIV serology testing. Again this HIV-EIA was positive, but the confirdoes not always follow the rules. The presence matory Western blot assay (HIV Blot 2.2, Diagnostic of HIV infection should be considered in a patient Biotechnology, Singapore) was negative. To avoid missshowing clinical signs of acute or late-stage HIV ing very early stages of HIV infection, HIV-antigen infection, even if the anti-HIV assay is negative.
(HIV-Ag) testing should be undertaken in such cases