Mj. Roy et al., ABSENCE OF TRUE SEROREVERSION OF HIV-1 ANTIBODY IN SEROREACTIVE INDIVIDUALS, JAMA, the journal of the American Medical Association, 269(22), 1993, pp. 2876-2879
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.