Health Education AIDS Liaison, Toronto
Whose antibodies are they anyway?
Compiled by Christine Johnson
Continuum Magazine Vol 4 No 3
The AIDS establishment has managed to convince many people that the HIV
antibody tests (ELISA, IFA and Western Blot) are "99.5% accurate". In this
article, Christine Johnson, from HEAL Los Angeles, lists conditions
documented in the scientific literature known to cause positives on these tests,
and gives her references.
It is expected that this list will generate much discussion and dissension. For the time
being, a few clarifications should be made from the outset.
Just because something is on this 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
the 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-positive
on ELISA, this probably 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 exposure 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 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 Western blot bands represent the various proteins to HIV, or just a
collection of false-positive bands reacting to several different non-HIV antibodies?
FACTORS KNOWN TO CAUSE FALSE POSITIVE HIV ANTIBODY TEST RESULTS
Anti-carbohydrate antibodies 52,19,13
Naturally-occurring antibodies 5,19
Passive immunization: receipt of gamma globulin or immune globulin (as
prophylaxis against infection which contains antibodies)18, 26, 60,4,22, 42, 43,13
Leprosy 2, 25
Mycobacterium avium 25
Systemic lupus erythematosus15, 23
Renal (kidney) failure 48, 23,13
Hemodialysis/renal failure 56,16, 41,10, 49
Alpha interferon therapy in hemodialysis patients 54
Flu vaccination 30,11, 3, 20,13, 43
Herpes simplex I 27
Herpes simplex II 11
Upper respiratory tract infection (cold or flu) 11
Recent viral infection or exposure to viral vaccines 11
Pregnancy in multiparous women 58, 53,13, 43, 36
Malaria 6, 12
High levels of circulating immune complexes 6, 33
Hypergammaglobulinemia (high levels of antibodies) 40, 33
False positives on other tests, including RPR (rapid plasma reagent) test for
syphilis17, 48, 33,10, 49
Rheumatoid arthritis 36
Hepatitis B vaccination 28, 21, 40, 43
Tetanus vaccination 40
Organ transplantation 1, 36
Renal transplantation 35, 9, 48,13, 56
Anti-lymphocyte antibodies 56, 31
Anti-collagen antibodies (found in gay men, haemophiliacs, Africans of both sexes
and people with leprosy) 31
Serum-positive for rheumatoid factor, antinuclear antibody (both found in
rheumatoid arthritis and other autoantibodies) 14, 62, 53
Autoimmune diseases 44, 29, 1O, 40, 49, 43: Systemic lupus erythematosus,
scleroderma, connective tissue disease, dermatomyositis
Acute viral infections, DNA viral infections 59, 48, 43, 53, 40, 13
Malignant neoplasms (cancers) 40
Alcoholic hepatitis/alcoholic liver disease 32, 48, 40,10,13, 49, 43, 53
Primary sclerosing cholangitis 48,53
"Sticky" blood (in Africans) 38, 34, 40
Antibodies with a high affinity for polystyrene (used in the test kits) 62, 40, 3
Blood transfusions, multiple blood transfusions 63, 36,13, 49, 43, 41
Multiple myeloma 10, 43, 53
HLA antibodies (to Class I and II leukocyte antigens) 7, 46, 63, 48,10, 13, 49, 43,
Anti-smooth muscle antibody 48
Anti-parietal cell antibody 48
Anti-hepatitis A IgM (antibody) 48
Anti-Hbc IgM 48
Administration of human immunoglobulin preparations pooled before1985 10
Haemophilia 10, 49
Haematologic malignant disorders/lymphoma 43, 53, 9, 48, 13
Primary biliary cirrhosis 43, 53, 13, 48
Stevens-Johnson syndrome 9, 48, 13
Q-fever with associated hepatitis61Heat-treated specimens 51, 57, 24, 49, 48
Lipemic serum (blood with high levels of fat or lipids) 49
Haemolyzed serum (blood where haemoglobin is separated from the red cells) 49
Hyperbilirubinemia 10, 13
Globulins produced during polyclonal gammopathies (which are seen in AIDS risk
groups)10, 13, 48
Healthy individuals as a result of poorly-understood cross-reactions10
Normal human ribonucleoproteins 48,13
Other retroviruses 8, 55,14, 48,13
Anti-mitochondrial antibodies 48,13
Anti-nuclear antibodies 48,13, 53
Anti-microsomal antibodies 34
T-cell leukocyte antigen antibodies 48,13
Proteins on the filter paper 13
Epstein-Barr virus 37
Visceral leishmaniasis 45
Receptive anal sex 39, 64
© Sept. 1996, Zenger's, California
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 acause 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 upof influenza vaccine-related
multiple viral enzyme immunoassayreactivity. 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 haveantibodies 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 retrovirusantibody 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. Identificationof regions of HIV-1 p24 reactive
with sera which give "indeterminate"results in electrophoretic immunoblots with the help of long
syntheticpeptides. 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 andDuPont 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 ofatypical
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 testsfor 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 lymphotropicvirus 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 lymphotropicviruses 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
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 Cfollowing 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 withhepatitis. 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. Whichanti-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-
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. June11:696-707.
40. Pearlman ES, Ballas SK. 1994. False-positive humanimmunodeficiency 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 ofhuman 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 causeof false-positive reactions in
screening enzyme immunoassays forantibodies to human T-lymphotropic virus type III [HIV]. Transfusion.
47. Sayre KR, Dodd RY, Tegtmeier G, et al. 1996. False-positive human
immunodeficiency virus type 1 Western blot tests in non-infectedblood 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 thedetection of human immunodeficiency
virus infection. In AIDS Testing Methodologyand Management Issues, Springer-Verlag, New York.
50. Simonsen L, Buffington J, Shapiro C, et al. 1995. Multiplefalse reactions in viral antibody
screening assays after influenzavaccination.
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.
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.
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 enzymeimmunoassays. 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.
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 Institute of Justice, AIDS Bulletin. Oct. 1988.