Comparison of a rapid nonisotopic polymerase chain reaction assay with four commonly used methods for the early diagnosis of human immunodeficiency virus type 1 infection in neonates and children

Abstract

To initiate antiretroviral therapy and prophylaxis for Pneumocystis carinii pneumonia, it is important to identify human immunodeficiency virus (HIV-1)-infected infants as soon after birth as possible. This study was undertaken to evaluate a novel 5-hour nonisotopic (NI) polymerase chain reaction (PCR) assay (Amplicor PCR; Roche Molecular Systems) and four other commonly used HIV-1 diagnostic tests including culture, oligonucleotide hybridization PCR, p24 antigen and immune complex-dissociated (ICD) p24 antigen tests and to determine the optimal age at which to perform these tests for the early and rapid diagnosis of HIV-1 in infants and children. We prospectively evaluated 225 infants and children, including 114 neonates, for HIV-1 infection. HIV-1 infection was defined as 2 positive HIV cultures. Of the 225 infants and children, 57 were infected, 138 were uninfected and 30 were of unknown (Centers for Disease Control and Prevention Classification P0) status. The sensitivity of NI PCR was 60% in cord blood, 40% at 0 to 2 days, 67 to 80% in the neonate (3 to 30 days) and 95 to 100% after 1 month of age. NI PCR was as sensitive as oligonucleotide hybridization PCR, culture, p24 antigen and ICD p24 antigen in the first 2 months of life and was more sensitive than p24 antigen or ICD p24 antigen thereafter. Specificity was 94% for cord blood and 99 to 100% for all age groups. The majority of HIV-1-infected newborns can be identified with NI PCR if testing is performed at birth and again between the third and fourth weeks of life. For older infants and children 2 NI PCR tests can correctly diagnose 98.5% of infected and uninfected infants and children. NI PCR of umbilical cord blood might also be useful as an initial screening test to identify infants who may be infected with HIV-1.