Polymerase Chain Reaction for Diagnosis of Human Immunodeficiency Virus Infection in Infancy in Low Resource Settings

Department of Molecular Medicine and Haematology, National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa.
The Pediatric Infectious Disease Journal (Impact Factor: 2.72). 12/2005; 24(11):993-7. DOI: 10.1097/01.inf.0000187036.73539.8d
Source: PubMed


Diagnosis of human immunodeficiency virus (HIV) is essential for accessing treatment. Current HIV diagnostic protocols for infants require adaptation and validation before they can be implemented in the developing world. The timing and type of HIV assays will be dictated by country-specific circumstances and experience from similar settings. The performance of an HIV-1 DNA polymerase chain reaction (PCR) test, and in particular a single test at 6 weeks of age, in diagnosing HIV subtype C infection acquired in utero or peripartum was assessed.
A retrospective review of 1825 Amplicor HIV-1 DNA PCR version 1.5 tests performed between 2000 and 2004 in 2 laboratories in Johannesburg, South Africa on 769 effectively non-breast-fed infants from 3 clinically well characterized cohorts was undertaken. The HIV status of each infant was used as the standard against which the HIV PCR results were compared.
The overall sensitivity and specificity of the HIV PCR test were 99.3 and 99.5% respectively. A single test was 98.8% sensitive and 99.4% specific in the 627 infants tested at 6 weeks of age (58 HIV-infected and 569 HIV-uninfected). Repeat testing of all positive HIV PCR tests minimized false positive results.
In resource-poor settings where HIV PCR testing in an environment of good laboratory practice is feasible, a single 6-week HIV DNA PCR test can increase identification of HIV-infected children substantially from current levels. Further operational research on how best to implement and monitor such a diagnostic protocol in specific local settings, especially in breast-fed infants, is necessary.

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Available from: Gayle Sherman, May 27, 2014
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    • "Infected infants have a high morbidity and mortality in the first 2 years of life; thus, it is important to promptly establish the infection status of the exposed infant in order to employ appropriate ART sufficiently early.10,11 Qualitative nucleic acid assays for the detection of HIV pro-viral DNA,12 viral RNA13,14 and total nucleic acids13,15 have become the methods of choice for diagnosis in infants born to HIV-1-infected mothers.12,16 "
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    • "HIV technologies for diagnosis have included direct detection approaches based on specific viral antigen quantification such as the p24 antigen [3] and qualitative nucleic acid amplification tests (NATs) such as polymerase chain reaction (RT-PCR) amplification [4–6], and indirect or antibody-based tests such as Western blots, direct or indirect ELISA or EIA formulated into POC rapid diagnostic tests (RDTs) are widely available [7, 8]. The rapid scale-up of POC testing seen in recent times is largely attributed to successful concepts such as portable glucometers, urinalysis dipsticks, and hemoglobin spectrophotometers (e.g., HemoCue), but particularly for HIV screening using RDT [7, 8]. "
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