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HIV‐1 Causing AIDS and Death in a Seronegative Individual

A 26-year-old Gipsy male was referred to the Hospital General Penitenciario (Madrid) in June 93 because of progressive clinical deterioration 6 months after he had been diagnosed and treated for disseminated tuberculosis. The illness had started with fever, cachexia, adenopathies, productive cough and dyspnea in December 1992. A chest radiography revealed diffuse infiltrates, and sputum smears showed acid-fast bacilli. Antituberculous therapy was instituted immediately but had to be transiently interrupted because of hepatotoxicity. Esophageal candidiasis was additionally diagnosed at that time. The patient admitted sporadic use of intravenous illicit drugs. He had not visited non-European countries in the past. HIV-1+2 secondand third-generation ELISA tests (Abbott. Murex, Ortho, and BioKit) were repeatedly negative. In addition, a commercial Western blot (BioKit) showed complete absence of bands. However, in December 1992 the CD4+ T cell count was 208imm' and HIV-I p24 antigen test was strongly positive. In spite of appropriate antituberculous therapy, his clinical status deteriorated, the CD4+ count fell to 120/mm', and in July 1993 the patient developed penicillin-resistant pneumonia due to Streptococcus pneumoniae and died. Permission for autopsy was denied. The polymerase chain reactions (PCR) using HIV-1 gag, pol and env primers were all reactive in DNA from PBMCs collected in June 1993. Viral culture as well as HIV-I p24 HIV-1 Causing AIDS and Death in a Seronegative Individual