HIV diagnostics in infants vertically exposed and receiving anti-retroviral treatment

Abstract

In this multicenter, prospective, cohort study of neonates born to mothers infected with HIV, the value of performance of testing for both HIV-1 DNA and HIV-1 RNA was compared in infant aged ≤ 6 months. The novelty of this investigation is that the 1567 studied infants exposed to HIV received postnatal prophylaxis (and were not breastfed). The DNA and RNA tests performed similarly as diagnostic tests. Although both HIV-1 RNA and HIV-1 DNA polymerase chain reaction (PCR) tests had specificity of 100% for infants infected with HIV (except in first few postnatal days), sensitivity of tests rose to 100% only at 3 months of age (after discontinuation of 4-6 week course of anti-retroviral prophylaxis). At 1 month of age, 11% of children infected with HIV had negative DNA and RNA PCR test results. Our expert reviewers suggested that these data make the current World Health Organization's goal of diagnosing HIV-1 infections using tests with at least 95% sensitivity for all infants exposed to HIV by 4-6 weeks of age nonfeasible given the current standard of peri- and postnatal management and current limitations of viral detection methodology. Article page 60▶ Performance of HIV-1 DNA or HIV-1 RNA Tests for Early Diagnosis of Perinatal HIV-1 Infection during Anti-Retroviral ProphylaxisThe Journal of PediatricsVol. 160Issue 1PreviewTo 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. Full-Text PDF