It is expected that this list will generate much discussion and dissension. For the time being, a few clarifications should be made at the outset.
Just because something is on the list doesn't mean that it will definitely, or even probably, cause a false-positive. It depends on what antibodies the individual carries; as well as the characteristics of each particular test kit.
For instance, some, but not all, people who have had blood transfusions, prior pregnancies or an organ transplant will make HLA antibodies. And some, but not all, test kits (both ELISA and Western blot) will be contaminated with HLA antigens to which these antibodies can react. Only if these two conditions coincide might you get a false-positive due to HLA cross-reactivity.
Some things are more likely than others to cause false-positives. And some things that we aren't aware of yet, but which may be documented in the future, may cause false-positives. Some of the factors on the list have been documented only for ELISA, some for both ELISA and Western blot (WB).
Some people may be eager to argue that if a factor is only known to cause false-positives on ELISA, this problem won't be carried over to the WB, so everything should be OK. But remember, a WB is positive by virtue of accumulating enough individual positive bands to add up to the total required by whatever criteria you use to interpret it (39) So the more exposures a person has had to foreign antigens, proteins and infectious agents, the more various antibodies he or she will have in their system, and the more likely it is that there will be several cross-reacting antibodies, enough to make the WB positive.
It is to be noted that all AIDS risk groups (and Africans as well), but not the general US or Western European population, have this problem in common: they have been exposed to a plethora of foreign antigens and proteins. This is why people in the AIDS "risk groups" tend to have positive WBs (i.e., to be considered "HIV-infected") and people in the general population don't. However, even people in the low-risk populations may have false-positive Western blots for poorly understood reasons.(47)
Since false-positives to every single HIV protein have been documented (36), how do you know the positive WB bands represent the various proteins to HIV, or just a collection of false-positive bands reacting to several different non-HIV antibodies?
1. Agbalika F, Ferchal F, Garnier J-P, et al. 1992.
False-positive
antigens related to emergence of a 25-30 kD protein detected in organ
recipients. AIDS. 6:959-962.
2. Andrade V, Avelleira JC, Marques A, et al. 1991. Leprosy as a
cause
of false-positive results in serological assays for the detection of
antibodies to HIV-1. Intl. J. Leprosy. 59:125.
3. Arnold NL, Slade RA, Jones MM, et al. 1994. Donor follow up
of
influenza vaccine-related multiple viral enzyme immunoassay
reactivity. Vox
Sanguinis. 67:191.
4. Ascher D, Roberts C. 1993. Determination of the etiology of
seroreversals in HIV testing by antibody fingerprinting. AIDS. 6:241.
5. Barbacid M, Bolgnesi D, Aaronson S. 1980. Humans have
antibodies
capable of recognizing oncoviral glycoproteins: Demonstration that
these
antibodies are formed in response to cellular modification of
glycoproteins
rather than as consequence of exposure to virus. Proc. Natl. Acad.
Sci.
77:1617-1621.
6. Biggar R, Melbye M, Sarin P, et al. 1985. ELISA HTLV
retrovirus
antibody reactivity associated with malaria and immune complexes in
healthy
Africans. Lancet. ii:520-543.
7. Blanton M, Balakrishnan K, Dumaswala U, et al. 1987. HLA
antibodies
in blood donors with reactive screening tests for antibody to the
immunodeficiency virus. Transfusion. 27(1):118.
8. Blomberg J, Vincic E, Jonsson C, et al. 1990. Identification
of
regions of HIV-1 p24 reactive with sera which give "indeterminate"
results
in electrophoretic immunoblots with the help of long synthetic
peptides.
AIDS Res. Hum. Retro. 6:1363.
9. Burkhardt U, Mertens T, Eggers H. 1987. Comparison of two
commercially available anti-HIV ELISA's: Abbott HTLV-III ELA and
DuPont
HTLV-III ELISA. J. Med. Vir. 23:217.
10. Bylund D, Ziegner U, Hooper D. 1992 Review of testing for
human
immunodeficiency virus. Clin. Lab. Med. 12:305-333.
11. Challakere K, Rapaport M. 1993. False-positive human
immunodeficiency virus type 1 ELISA results in low-risk subjects.
West. J.
Med. 159(2):214-215.
12. Charmot G, Simon F. 1990. HIV infection and malaria. Revue du
practicien. 40:2141.
13. Cordes R, Ryan M. 1995. Pitfalls in HIV testing. Postgraduate
Medicine. 98:177.
14. Dock N, Lamberson H, O'Brien T, et al. 1988. Evaluation of
atypical
human immunodeficiency virus immunoblot reactivity in blood donors.
Transfusion. 28:142.
15. Esteva M, Blasini A, Ogly D, et al. 1992. False positive
results
for antibody to HIV in two men with systemic lupus erythematosus.
Ann.
Rheum. Dis. 51:1071-1073.
16. Fassbinder W, Kuhni P, Neumayer H. et al. 1986. Prevalence of
antibodies against LAV/HTLV-III [HIV] in patients with terminal renal
insufficiency treated with hemodialysis and following renal
transplantation. Deutsche Medizinische Wochenschrift. 111:1087.
17. Fleming D, Cochi S, Steece R. et al. 1987. Acquired
immunodeficiency syndrome in low-incidence areas. JAMA. 258(6):785.
18. Gill MJ, Rachlis A, Anand C. 1991. Five cases of erroneously
diagnosed HIV infection. Can. Med. Asso. J. 145(12):1593.
19. Healey D, Bolton W. 1993. Apparent HIV-1 glycoprotein
reactivity on
Western blot in uninfected blood donors. AIDS. 7:655-658.
20. Hisa J. 1993. False-positive ELISA for human immunodeficiency
virus
after influenza vaccination. JID. 167:989.
21. Isaacman S. 1989. Positive HIV antibody test results after
treatment with hepatitis B immune globulin. JAMA. 262:209.
22. Jackson G, Rubenis M, Knigge M, et al. 1988. Passive
immunoneutralisation of human immunodeficiency virus in patients with
advanced AIDS. Lancet, Sept. 17:647.
23. Jindal R, Solomon M, Burrows L. 1993. False positive tests
for HIV
in a woman with lupus and renal failure. NEJM. 328:1281-1282.
24. Jungkind D, DiRenzo S, Young S. 1986. Effect of using
heat-inactivated serum with the Abbott human T-cell lymphotropic
virus type
III [HIV] antibody test. J. Clin. Micro. 23:381.
25. Kashala O, Marlink R, Ilunga M. et al. 1994. Infection with
human
immunodeficiency virus type 1 (HIV-1) and human T-cell lymphotropic
viruses
among leprosy patients and contacts: correlation between HIV-1
cross-reactivity and antibodies to lipoarabionomanna. J. Infect. Dis.
169:296-304.
26. Lai-Goldman M, McBride J, Howanitz P, et al. 1987. Presence
of
HTLV-III [HIV] antibodies in immune serum globulin preparations. Am.
J.
Clin. Path. 87:635.
27. Langedijk J, Vos W, Doornum G, et al. 1992. Identification of
cross-reactive epitopes recognized by HIV-1 false-positive sera.
AIDS.
6:1547-1548.
28. Lee D, Eby W, Molinaro G. 1992. HIV false positivity after
hepatitis B vaccination. Lancet. 339:1060.
29. Leo-Amador G, Ramirez-Rodriguez J, Galvan-Villegas F, et al.
1990.
Antibodies against human immunodeficiency virus in generalized lupus
erythematosus. Salud Publica de Mexico. 32:15.
30. Mackenzie W, Davis J, Peterson D. et al. 1992. Multiple
false-positive serologic tests for HIV, HTLV-1 and hepatitis C
following
influenza vaccination, 1991. JAMA. 268:1015-1017.
31. Mathe G. 1992. Is the AIDS virus responsible for the disease?
Biomed & Pharmacother. 46:1-2.
32. Mendenhall C, Roselle G, Grossman C, et al. 1986.
False-positive
tests for HTLV-III [HIV] antibodies in alcoholic patients with
hepatitis.
NEJM. 314:921.
33. Moore J, Cone E, Alexander S. 1986. HTLV-III [HIV]
seropositivity
in 1971-1972 parenteral drug abusers - a case of false-positives or
evidence of viral exposure? NEJM. 314:1387-1388.
34. Mortimer P, Mortimer J, Parry J. 1985. Which
anti-HTLV-III/LAV
[HIV] assays for screening and comfirmatory testing? Lancet. Oct. 19,
p873.
35. Neale T, Dagger J, Fong R, et al. 1985. False-positive
anti-HTLV-III [HIV] serology. New Zealand Med. J. October 23.
36. Ng V. 1991. Serological diagnosis with recombinant
peptides/proteins. Clin. Chem. 37:1667-1668.
37. Ozanne G, Fauvel M. 1988. Perfomance and reliability of five
commercial enzyme-linked immunosorbent assay kits in screening for
anti-human immunodeficiency virus antibody in high-risk subjects. J.
Clin.
Micro. 26:1496.
38. Papadopulos-Eleopulos E. 1988. Reappraisal of AIDS - Is the
oxidation induced by the risk factors the primary cause? Med. Hypo.
25:151.
39. Papadopulos-Eleopulos E, Turner V, and Papadimitriou J. 1993.
Is a
positive Western blot proof of HIV infection? Bio/Technology. June
11:696-707.
40. Pearlman ES, Ballas SK. 1994. False-positive human
immunodeficiency
virus screening test related to rabies vaccination. Arch. Pathol.
Lab. Med.
118-805.
41. Peternan T, Lang G, Mikos N, et al. Hemodialysis/renal
failure.
1986. JAMA. 255:2324.
42. Piszkewicz D. 1987. HTLV-III [HIV] antibodies after immune
globulin. JAMA. 257:316.
43. Profitt MR, Yen-Lieberman B. 1993. Laboratory diagnosis of
human
immunodeficiency virus infection. Inf. Dis. Clin. North Am. 7:203.
44. Ranki A, Kurki P, Reipponen S, et al. 1992. Antibodies to
retroviral proteins in autoimmune connective tissue disease.
Arthritis and
Rheumatism. 35:1483.
45. Ribeiro T, Brites C, Moreira E, et al. 1993. Serologic
validation
of HIV infection in a tropical area. JAIDS. 6:319.
46. Sayers M, Beatty P, Hansen J. 1986. HLA antibodies as a cause
of
false-positive reactions in screening enzyme immunoassays for
antibodies to
human T-lymphotropic virus type III [HIV]. Transfusion. 26(1):114.
47. Sayre KR, Dodd RY, Tegtmeier G, et al. 1996. False-positive
human
immunodeficiency virus type 1 Western blot tests in non-infected
blood
donors. Transfusion. 36:45.
48. Schleupner CJ. Detection of HIV-1 infection. In: (Mandell GI,
Douglas RG, Bennett JE, eds.) Principles and Practice of Infectious
Diseases, 3rd ed. New York: Churchill Livingstone, 1990:1092.
49. Schochetman G, George J. 1992. Serologic tests for the
detection of
human immunodeficiency virus infection. In AIDS Testing Methodology
and
Management Issues, Springer-Verlag, New York.
50. Simonsen L, Buffington J, Shapiro C, et al. 1995. Multiple
false
reactions in viral antibody screening assays after influenza
vaccination.
Am. J. Epidem. 141-1089.
51. Smith D, Dewhurst S, Shepherd S, et al. 1987. False-positive
enzyme-linked immunosorbent assay reactions for antibody to human
immunodeficiency virus in a population of midwestern patients with
congenital bleeding disorders. Transfusion. 127:112.
52. Snyder H, Fleissner E. 1980. Specificity of human antibodies
to
oncovirus glycoproteins; Recognition of antigen by natural antibodies
directed against carbohydrate structures. Proc. Natl. Acad. Sci.
77:1622-1626.
53. Steckelberg JM, Cockerill F. 1988. Serologic testing for
human
immunodeficiency virus antibodies. Mayo Clin. Proc. 63:373.
54. Sungar C, Akpolat T, Ozkuyumcu C, et al. Alpha interferon
therapy
in hemodialysis patients. Nephron. 67:251.
55. Tribe D, Reed D, Lindell P, et al. 1988. Antibodies reactive
with
human immunodeficiency virus gag-coated antigens (gag reactive only)
are a
major cause of enzyme-linked immunosorbent assay reactivity in a bood
donor
population. J. Clin. Micro. April:641.
56. Ujhelyi E, Fust G, Illei G, et al. 1989. Different types of
false
positive anti-HIV reactions in patients on hemodialysis. Immun. Let.
22:35-40.
57. Van Beers D, Duys M, Maes M, et al. Heat inactivation of
serum may
interfere with tests for antibodies to LAV/HTLV-III [HIV]. J. Vir.
Meth.
12:329.
58. Voevodin A. 1992. HIV screening in Russia. Lancet. 339:1548.
59. Weber B, Moshtaghi-Borojeni M, Brunner M, et al. 1995.
Evaluation
of the reliability of six current anti-HIV-1/HIV-2 enzyme
immunoassays. J.
Vir. Meth. 55:97.
60. Wood C, Williams A, McNamara J, et al. 1986. Antibody against
the
human immunodeficiency virus in commercial intravenous gammaglobulin
preparations. Ann. Int. Med. 105:536.s
61. Yale S, Degroen P, Tooson J, et al. 1994. Unusual aspects of
acute
Q fever-associated hepatitis. Mayo Clin. Proc. 69:769.
62. Yoshida T, Matsui T, Kobayashi M, et al. 1987. Evaluation of
passive particle agglutination test for antibody to human
immunodeficiency
virus. J. Clin. Micro. Aug:1433.
63. Yu S, Fong C, Landry M, et al. 1989. A false positive HIV
antibody
reaction due to transfusion-induced HLA-DR4 sensitization.
NEJM.320:1495.
64. National Institue of Justice, AIDS Bulletin. Oct. 1988.