Abstract
BackgroundPrenatal human immunodeficiency virus (HIV) testing is essential for the prevention of mother-to-child transmission. However, false-positive results of screening testing are a concern as they may cause unnecessary emotional stress to pregnant women waiting for confirmatory test results. In regions with an extremely low prevalence, the positive predictive values of screening are unacceptably low rate. Here, we propose a HIV screening algorithm consisting of serial two fourth-generation enzyme immunoassays to reduce the number of false-positive screening results.Methodology/Principal FindingsWhen 6461 pregnant women presenting to two maternity hospitals located in the Tokyo metropolitan area of Japan from September, 2004 to January, 2006 were tested using Enzygnost HIV Integral as a first screening test, 27 showed positive reactions. When these positive reaction samples were tested using VIDAS HIV DUO Quick as a second screening test, only one of them had a positive reaction, and the remaining 26 were nonreactive. Confirmatory Western blots and nucleic acid amplification test also showed that one was positive and the remaining 26 were negative; the subject who was positive with the confirmatory tests was identical to the subject who was positive with the second screening test. Thus, by adding the second screening test, the false-positive rate was improved from 0.4% to 0%, and the positive predictive value from 3.7% to 100%, compared with the single screening test.ConclusionBy applying our serial screening algorithm to HIV testing in maternity hospitals, many uninfected pregnant women would not need to receive confirmatory tests and be subjected to emotional turmoil while waiting for their confirmatory test results. This algorithm would be suitable for HIV testing of pregnant women living in low prevalence regions such as Japan.
Highlights
The human immunodeficiency virus (HIV) epidemic in Japan is still at a low level compared with other developed countries, but the number of newly identified infections is increasing every year
By applying our serial screening algorithm to HIV testing in maternity hospitals, many uninfected pregnant women would not need to receive confirmatory tests and be subjected to emotional turmoil while waiting for their confirmatory test results. This algorithm would be suitable for HIV testing of pregnant women living in low prevalence regions such as Japan
HIV infection was detected with the VIDAS HIV DUO Quick earlier than with the Enzygnost HIV Integral in eight out of ten panels; the interval was an average of 4.5 days (Table 1)
Summary
The human immunodeficiency virus (HIV) epidemic in Japan is still at a low level compared with other developed countries, but the number of newly identified infections is increasing every year. According to the report of the National AIDS Surveillance Committee, 13,894 persons with HIV/. The HIV prevalence in Japan was estimated at 0.008% in 2007 [2]. Of all the HIV-infected persons reported in Japan, 71.0% were Japanese men; 11.4% were nonJapanese men; 6.2% were Japanese women; and 11.4% were nonJapanese women. Prenatal human immunodeficiency virus (HIV) testing is essential for the prevention of mother-to-child transmission. In regions with an extremely low prevalence, the positive predictive values of screening are unacceptably low rate. We propose a HIV screening algorithm consisting of serial two fourth-generation enzyme immunoassays to reduce the number of false-positive screening results
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