Performance of HIV-1 DNA or HIV-1 RNA tests for early diagnosis of perinatal HIV-1 infection during anti-retroviral prophylaxis
Laboratoire de Virologie, Hôpital Necker, AP-HP, Paris, France. The Journal of pediatrics
(Impact Factor: 3.79).
08/2011; 160(1):60-6.e1. DOI: 10.1016/j.jpeds.2011.06.053
To compare performance of testing for human immunodeficiency virus (HIV)-1 DNA and HIV-1 RNA for diagnosis of HIV-1 infection in infants receiving preventive antiretroviral therapy.
This substudy of the French multicenter prospective cohort of neonates born to HIV-infected mothers, included 1567 infants tested for HIV with polymerase chain reaction (PCR) in a single laboratory, receiving post-natal prophylaxis, not breastfed, and having simultaneous HIV-1 DNA and RNA results before 45 days. The performance of PCR was assessed in reference to the 6-month HIV-1 RNA result.
Specificity of both HIV-1 RNA and HIV-1 DNA PCR was 100% at all ages (except 99.8% for DNA at birth); sensitivity was 58% (RNA) and 55% (DNA) at birth, and 89% at 1 month, 100% at 3 months for both, and 100% at 6 months (DNA). Concordance between HIV-1 DNA and RNA results was 0.78 and 0.81 (Kappa) at birth and 1 month and 100% at 3 and 6 months. Type of maternal and neonatal prophylaxis had no effect on sensitivity, but influenced viral load.
The performances of testing for HIV-1 DNA and RNA were similar with 100% sensitivity at 3 months. At 1 month during prophylaxis, 11% of infected children had negative PCR results.
Available from: Kate Harding
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ABSTRACT: The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of human immunodeficiency virus (HIV)-positive pregnant women in the UK. The scope includes guidance on the use of antiretroviral therapy (ART) both to prevent HIV mother-to-child transmission (MTCT) and for the welfare of the mother herself, guidance on mode of delivery and recommendations in specific patient populations where other factors need to be taken into consideration,such as coinfection with other agents. The guidelines are aimed at clinical professionals directly involved with, and responsible for, the care of pregnant women with HIV infection.
Available from: Gayle Sherman
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Early initiation of antiretroviral therapy depends on an early infant diagnosis and is critical to reduce HIV-related infant mortality. We describe the implementation of a routine prevention of mother-to-child transmission program and focus on early infant diagnosis to identify opportunities to improve outcomes.
HIV-exposed infants and their mothers were enrolled in a prospective, observational cohort study at a routine, hospital-based prevention of mother-to-child transmission and HIV treatment service in Johannesburg, South Africa. Infant HIV status was determined by testing samples collected between birth and 6 weeks and searching the national laboratory information system for polymerase chain reaction results of defaulting infants who accessed testing elsewhere.
Of 838 enrolled infants, HIV status was determined for 606 (72.3%) by testing at the study site, 85 (10.1%) by accessing test results from other facilities, 19 (2.3%) by testing stored samples and remained unknown in 128 (15.3%) infants. In total, 38 perinatally HIV-infected infants were identified. Thirty (79%) HIV-infected infants accessed 6-week testing and initiated antiretroviral therapy at a median age of 16.0 weeks, but only 14 were in care a median of 68 weeks later and 4 had died. Eight (21%) HIV-infected infants, 2 of whom died, escaped identification by routine testing. Their mothers were younger, more likely to be foreign and accessed less optimal antenatal care.
Six-week testing delayed antiretroviral therapy initiation beyond the time of early HIV-related infant mortality and missed one-fifth of perinatally HIV-infected infants. Earlier diagnosis and improved retention in care are required to reduce infant mortality and accurately measure elimination of mother-to-child transmission.
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