João Paulo Neto
Hello!I found in one of the references given here a case of a 30-year-old woman who only converted after 21 months.Can you report more on this case?What are the reasons for a seroconversion to take place, as in this case?Pollett S, Wienholt L, Lee F, Adelstein S, MacLeod C, Chen R, et al
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helpline-volunteer
Hi there,

Thank you for your question.

After looking at the case study that you referred to, it seems that the patient in question is a very unique case. Western blot analyses have been documented to be indeterminate as late as 12 months following infection confirmed by initial detection of HIV-1 proviral DNA (proviral DNA is viral DNA that is integrated into the DNA of cells in our body) (1). There are also several other factors that have been associated with delayed Western blot positivity and the ones specific to this patient include malnutrition and profound immunodeficiency (2). The patient in the case had a concurrent hepatitis C infection which affects the CD4 T-cells, resulting in their death. Because of this, there could be a delayed response to the HIV infection by the body and a slower production of antibodies as a result. This would explain the rare and uncommon case of delayed seroconversion being detected on a Western blot from occurring. 

Other possible factors that can affect seroconversion not inclusive in this case include early treatment with antiretroviral therapy, HIV-1 elite controllers (unique population who control viral replication in the absence of antiretroviral therapy), humoral immunodeficiency and HIV-2 infection (2).

References:
(1) Delayed Western blot article
(2) Patient case

Thank you
AIDS Vancouver Helpline/Online, Shawn

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