ABSENCE OF TRUE SEROREVERSION OF HIV-1 ANTIBODY IN SEROREACTIVE INDIVIDUALS

Objectives.-First, to determine whether there is evidence for loss of human immunodeficiency virus type 1 (HIV-1) antibody in seroreactive i ndividuals. Second, if true seroreversion occurs, to determine its inc idence relative to errors in the testing process. Design.- A retrospec tive cohort study reviewing the results of 5 446 161 HIV-1 antibody te sts performed on 2 580 974 individuals (the US Army HIV Data System) f rom 1985 through 1992. For all patients with one or more seroreactive sample followed by one or more nonreactive sample, we examined availab le records and retested the samples. Participants.-Serum samples had b een obtained from active-duty and retired military personnel, their de pendents, and applicants to the military. Results.-Of 4911 individuals reported to be seroreactive for HIV-1 by two independent samples, onl y six were potential seroreverters. Review of the six cases revealed t hat five actually were HIV-seroreactive patients who had samples from nonreactive individuals mistakenly attributed to them, while the sixth had a testing error proven by retesting the discrepant specimen. Erro rs in the testing process were identified (n=23) or suspected (n=3) in another 26 individuals who had not had independent confirmation of re activity by a second sample. The cumulative error rate was 12.4 per 1 million patients tested. An additional group of 31 uninfected infants appeared to serorevert due to loss of antibody acquired from their HIV -1-infected mothers. Conclusions.-Review of this database demonstrates no evidence for true seroreversion of HIV-1 antibody status. We concl ude that if seroreversion occurs at all, it is exceedingly rare. In fa ct, most (if not all) cases of apparent seroreversion represent errors of attribution or testing.