Report of A False Positive Rapid HIV Test Due To Hepatitis A in A U.S. Army Soldier - Report of A False Positive Rapid HIV Test Due To Hepatitis A in A U.S. Army Soldier - Open Access Pub

A 25 year old, single, active duty soldier presented to a clinic in Afghanistan complaining of malaise, fatigue, acholic stools, and mild jaundice over a 5- to 7-day period. He had significantly elevated liver transaminase levels approaching 5000 U/L and a positive rapid human immunodeficiency (HIV) 1 antibody test. Ultimately, the patient was found to have a false positive rapid HIV-1 antibody test due to acute hepatitis A virus infection. This case report describes his evaluation and outcome, in addition to exploring possible causes of false positive HIV screening. DOI10.14302/issn.2324-7339.jcrhap-14-541 Human immunodeficiency virus (HIV) is a well-known sexually transmitted disease that accounts for significant morbidity and mortality. A report by the Centers for Disease Control and Prevention (CDC) approximated 1,144,400 cases of HIV in 2010 in the United States with about 21,278 cases of death from known HIV.1 Although HIV in the military is not of particular concern, all active duty personnel are required to have biennial HIV testing unless they are already HIV-positive. From 2008 to 2012, the incidence of HIV diagnosis among U.S. Army active component increased 22%. In 2012, 416,715 soldiers were tested and 111 (108 male) were found to be HIV-positive.2 Rapid HIV antibody testing allows for obtaining preliminary results within 20 to 30 minutes. This is advantageous in many populations including the military where early diagnosis can positively affect soldier and unit readiness. If positive, a rapid test is only considered a “preliminary positive” as confirmatory immunoassays and Western blots are necessary.3 Like conventional screening antibody immunoassays, a positive rapid result requires confirmatory testing. As with all screening tests, false-positive results occur. We describe the first case report of a false positive HIV antibody test due acute hepatitis A infection. Case A 25 year old, single, white, male Army soldier presented to a clinic in Afghanistan complaining of fatigue, malaise, nausea, chills, and acholic stools. He denied any sexual contact within the previous year and denied alcohol, tobacco, illicit drugs or supplement use. His only medication was doxycycline prescribed for malaria prophylaxis for which he was compliant. He worked closely with Afghani soldiers and frequently ate local food. Physical examination was remarkable for normal vital signs, mild hepatomegaly, and marked jaundice and scleral icterus. Initial laboratory testing was significant for aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at