Combined
p24 antigen-HIV antibody fourth-generation assays that identify most of the early
HIV infections have been used extensively worldwide for several years. This poses challenges for the traditional algorithm of line immunoassay (LIA) confirmation. LIA tests are useful methods with their high specificity and their ability to differentiate HIV-1 from HIV-2, but they are reactive days after the fourth generation
enzyme immunoassays. With acute
HIV infection, high levels of infectious virus are detectable in serum and genital secretions. The rate of transmission during acute
HIV infection is higher than the established
HIV infection, for this reason, new HIV testing strategies need to focus on sensitivity, especially for this highly contagious phase immediately after
infection. Serum sample of a patient sent to Ege University Hospital Clinical Virology Laboratory was repeatedly reactive with low signal/cutoff ratios with two different commercial fourth generation
enzyme immunoassays (Architect HIV Ag/Ab Combo
Reagent Kit, Abbott, Germany and Vidas HIV Duo Quick, Biomerieux, France). The sample was non-reactive with the LIA (INNO-LIA HIV I/II Score, Innogenetics, Belgium) and HIV
RNA (RealTime HIV-I Amplification
Reagent Kit, Abbott, USA) result was positive (4.1 x 10(5) copies/ml). With the presentation of this case, the role of LIA in the diagnosis of early
HIV infection and its place in test algorithms were questioned.