The results obtained in this study are consistent with previous reports. A previous study in MSM showed that a total of 36 of 13 677 (0.3%) antibody-negative samples were positive when nucleic acid detection was used [7]. Another study showed that 81% of acute HIV infections identified by nucleic acid detection in sexually transmitted disease (STD) clinics in New York City were found among MSM. That study also demonstrated that, without nucleic acid testing, 9% of HIV infections at STD clinics would have been missed [8]. Another study performed in Thailand in a high-risk population

showed that 11 of 6426 subjects (0.2%) were identified as acutely infected with HIV using pooled nucleic acid detection. These acutely HIV-infected subjects were mostly MSM, and the HIV prevalence ranged DAPT chemical structure from 17 to 28% [9]. Although the sensitivity of the fourth-generation ELISA screening test is Akt inhibitor reported to be 100% by the manufacturer, HIV-positive WB samples with particle agglutination reactivity only have previously been identified in our laboratory

(Dr H. Salomon, Head of the Laboratory, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina; personal communication). Although these cases were not very frequent (six of 7820 HIV tests performed over 4 years, representing 0.08%) and no such cases were found in the present study, particle agglutination could be useful to detect some cases that are not reactive by ELISA. The identification of four new HIV-positive individuals using nucleic acid detection represents 0.3% of this MSM population from Buenos Aires. Although patient follow-up was not specifically planned in the study, a high percentage of individuals with HIV-indeterminate WB results (86%) returned to disclose their HIV diagnosis, including the three HIV-positive individuals. However, this trend was not observed among patients with HIV-negative Astemizole WB but

discordant results in the screening assays, where only 19% of the patients returned. This indicates that patients rely most heavily on the WB result. However, our results suggest that physicians should issue special recommendations not only for those individuals with HIV-indeterminate WB results but also for those with HIV-negative WB results with reactive screening assays, especially in settings where high prevalence and incidence rates are observed (e.g. MSM). Although we did not obtain any samples with viral loads > 200 copies/mL among the HIV-negative WB tested samples, no conclusions can be drawn about the absence of HIV-positive cases in the group, because only a small percentage of samples (≈ 18%) could be studied.