Abstract

Background: Most cases of negative serology in proven human immunodeficiency virus (HIV) patients occur due to testing during the window period. However, true non-seroconversion is a phenomenon that should always be considered.
Case Presentation: A 13-year-old female with a family history of multi-drug resistant tuberculosis (MDR-TB) presented with cough without fever for 1 month. She was vitally stable and the physical examination was unremarkable. Chest X-ray was suggestive of active TB, sputum positive for acid-fast bacilli, and GeneXpert positive for Mycobacterium tuberculosis. Her HIV RNA polymerase chain reaction (PCR) was positive at 28,866 IU/ml. She was registered as presumed MDR-TB and started on anti-tuberculosis treatment. Serum specimen sent inadvertently 6 weeks later was positive for HIV- p24 antigen while negative for anti-HIV ½ on Determine HIV Early Detect fourth generation lateral flow assay. A fresh specimen 2 weeks later showed similar results and was also negative by Alinity HIV Ag/antibody Combo (Abbott Diagnostics) and Bio-Rad Geenius HIV-1/2 Supplemental Assay. HIV antibodies were still negative at 20 weeks (5 months) after positive PCR.
Conclusion: This is a case of a seronegative HIV/TB co-infected patient. Non-seroconversion should always be considered in patients with clinical suspicion and discordant results.

Key words: Seroconversion, tuberculosis, acquired immunodeficiency syndrome, human immunodeficiency virus, case report.