Human Immunodeficiency Virus Antibody Testing Research Articles

Cytomegalovirus Retinitis in the Absence of HIV or Immunosuppression

Cytomegalovirus (CMV) retinitis classically occurs in advanced human immunodeficiencyvirus (HIV) infection but is rare in other forms of immunosuppression. The authors report a case of CMV retinitis in an HIV-negative man with idiopathic CD4 lymphocytopenia (ICL). This is the first such case to be confirmed by polymerase chain reaction (PCR) of aqueous humor. Case report. A 69-year-old retired Chinese seaman presented with gradual visual deterioration. He was a diet controlled diabetic on regular steroids for presumed asthma. Examination showed no diabetic eye disease but confirmed acute retinal necrosis (ARN). Anterior chamber tapping of the aqueous humor was PCR positive for CMV. HIV antibody and RNA tests were negative but his full blood count revealed lymphocytopenia, with a low CD4+ subset. He responded to a 3-week course of intravenous ganciclovir therapy followed by suppressiveoral valganciclovir. CMV is associated with sight-threatening retinitis in HIV infection at CD4+ counts below 50 cells/microL and in transplant recipients or heavily immunosuppressed patients. Systemic steroids are a risk factor for clinical disease in these groups. It is extremely rare to report CMV eye disease in previously healthy individuals. This case illustrates that the condition does occur in association with ICL. Corticosteroids may be implicated in disease reactivation. Molecular METHODS are necessary to confirm the diagnosis.

Aversion towards HIV antibody testing in a tertiary institution in Nigeria

CONTEXT: Students in tertiary institutions are at risk of contracting Human Immunodeficiency Virus (HIV) because they fall within the age group that is sexually active. In Nigeria little has been reported on knowledge and attitude towards HIV antibody testing in this population.METHODS: A cross sectional study of 400 students was conducted using a self administered questionnaire. Participants were questioned about their knowledge and attitude regarding HIV antibody testing. Descriptive analyses were performed.RESULTS: Knowledge of HIV testing was highest among male respondents (22.4%) compared with females (15.2%). (p=0.07). However, knowledge about HIV testing centres was low with as high as 320 (80.0%) respondents not knowing any place. Attitude toward HIV testing was poor. Almost all the participants, 391 (97.8%) claimed that they had never undergone HIV antibody testing. Lack of adequate information of HIV testing (13.9%) and fear of outcome of result were also responsible for aversion to HIV testing.
 CONCLUSION: High knowledge about HIV /AIDS does not suggest willingness to go for HIV antibody testing. There is need for more health education on HIV antibody testing among students of tertiary education in Nigeria.

Evaluation of the performance of HIV1 & 2 one-step selftest kit for detection of HIV infection in whole human blood, serum or plasma samples.

Acquired immune deficiency syndrome (AIDS) is cause by Human Immunodeficiency Virus (HIV). It is an enveloped RNA virus belonging to the family of retroviruses responsible for destroying the human immune defence system. HIV antibody testing is critical for the diagnosis and counselling of HIV-infected persons, monitoring of trends in HIV prevalence, and evaluation of the effectiveness of HIV prevention programmes. Serological tests to detect antibodies to HIV became available in 1985, and since then more kits for this test are still being produced. A total of 500 positive and 500 negative samples were screened for HIV antibodies using Genie II HIV 1 & 2(BIO-RAD; 3, Boulevard Raymond Poincare 92430 MARNES LA COQUETTE- FRANCE) and SeroCard™ HIV 1 & 2 Rapid (Trinity Biotech PLC; IDA Business Park Bray Co. Wicklow Ireland.) and were further confirmed using New Lav Blot 1 western blot kit (BIO-RAD; 3, Boulevard Raymond Poincare 92430 MARNES LA COQUETTE- FRANCE). These samples were screened using the HIV1 & 2 one-step self-test kit (Bremancos Diagnostics Inc. BDI with lot Number 0141503) to evaluate its performance. Whole blood, serum or plasma was used for the evaluation. Sensitivity of 99.2% and specificity of 99.8% were observed from the three sets of tests conducted while positive predictive value (PPV) of 0.99 and negative predictive value (NPV) of 0.99 each were calculated. The HIV 1 & 2 one-step-self test kit compared well with Genie II HIV1 & 2 kit and western blot kit for detecting HIV antibodies in patient\'s samples. Whole blood, plasma or serum can be used for the screening and easy for self test. Keywords: HIV; AIDS; Genie II HIV I &2; SeroCard™ HIV 1&2 Rapid; New Lav Blot 1; HIV1 & 2 one-step-self test.JOPAT Vol. 12 2007: pp.51-55

Prevalence of HIV-associated cryptococcal meningitis and utility of microbiological determinants for its diagnosis in a tertiary care center

Human immunodeficiency virus (HIV) infection continues to be the most important risk factor for the development of central nervous system (CNS) cryptococcosis, which in turn is an important contributor to morbidity and mortality in HIV-infected patients. Early diagnosis of such patients is the key to their therapeutic success. This study was undertaken to find out the prevalence of CNS cryptococcosis and to assess the role of microbiological parameters for its specific diagnosis in HIV-reactive hospitalized patients admitted with meningeal signs in a tertiary care setting. A total of 104 patients suspected to be suffering from meningitis/meningoencephalitis were subjected to cerebrospinal fluid (CSF) analysis (including India ink preparation, culture by conventional methods and Bactec MGIT 960 system, antigen detection) and tests for HIV antibodies by standard laboratory operating procedures. The prevalence of HIV infection in our study group was 12.5% (13/104), while the prevalence of cryptococcal CNS infection in HIV-reactive cohort was 46% (6/13). Additionally, 15.3% (2/13) of the patients from this cohort were positive for Mycobacterium tuberculosis. High prevalence of cryptococcal CNS infections in HIV-infected patients underscores the importance of precise and early microbiological diagnosis for better management of such patients.

The Trap

The Centers for Disease Control and Prevention, national public health agencies, and an expert committee of the European Commission have recently published updated guidelines on postexposure prophylaxis (PEP) of occupational human immunodeficiency virus (HIV) exposure. 1,2 Management of occupational HIV exposure relies heavily on HIV antibody testing of the source patient. However, patients with acute HIV infection may be antibody negative yet particularly contagious because of high viremia. We report 2 cases involving health care workers who were exposed to patients with acute primary HIV infection (PHI). The patients were in the window period of seroconversion, during which detection of HIV p24 antigen provided the definitive indication for PEP. We also review the literature on the topic.

Lymphadenitis in an 18-Month-Old Traveler to Mexico

Lymphadenitis in an 18-Month-Old Traveler to Mexico

Manifestations and Treatment of Ocular Syphilis During an Epidemic in France

To review cases of ocular syphilis presenting to a tertiary uveitis clinic during a syphilis epidemic in France between January 2001 and January 2004. Retrospective chart and patient database review. Ten patients who presented with symptoms and signs of uveitis tested positive for active syphilis. Some of the patients also presented with a rash or headache. Human immunodeficiency virus (HIV) antibody testing was positive in eight of the 10 patients, with CD4 cell counts >200 cells/mm3 in seven of the patients. Ocular inflammation resolved and visual acuity improved in all patients after treatment. A diagnosis of ocular syphilis should be considered in any patient with visual loss associated with a rash or headache, irrespective of the patient's CD4 cell count. Ocular syphilis in HIV-positive patients should be treated as neurosyphilis, whereas ocular syphilis in non-HIV patients can be treated as secondary syphilis.

Clinical significance of TOAST typing of ischemic stroke in young adults*

Background Ischemic stroke in young adults brings extremely hurts for their families and society, and the etiological factors and risk factors are different in the world. Objective To analyze and evaluate clinical significance of ischemic stroke in young adults by using TOAST typing. Design Case analysis. Setting Department of Neurology, the First Affiliated Hospital, Guangxi Medical University. Participants A total of 64 young adults with acute ischemic stroke were selected from the Department of Neurology, the First Affiliated Hospital, Guangxi Medical University from September 2005 to June 2006. There were 44 males and 20 females and their age ranged from 15 to 45 years. All patients met with the diagnostic criteria of the Fourth National Cerebrovarscular Academic Meeting and certainly diagnosed with CT or MRI examination. In addition, all patients provided the confirmed consent. Methods ▪ TOAST typing: Based on X-ray of thoracic part, electrocardiography, blood routine, blood glucose, electrolure, lipid, blood coagulation test, anticardiolipin antibody, antinuclear antibody, anti-double chain DNA, antineutrophil cytoplasmic antibody, crook agglutination test, syphilis antibody and human immunodeficiency virus (HIV) antibody test, patients received TOAST typing, including large-artery atherosclerotic stroke (LA), small-artery occlusion lacunar (SA), cardioembolism (CE), stroke of other demonstrated etiology (SOE), and stroke of other undemonstrated etiology (SUE). ▪ Risk factors: Stages of hypertension, diabetes mellitus, hyperlipemia, smoking and drinking of patients were observed. Blood pressure was measured twice after onset of acute stroke, and values of total cholesterol (TC) and/or triacylglycerol (TG) were measured more than twice to finally diagnose hyperlipemia. Diagnostic criteria of diabetes mellitus: fasting ≥ 7.0 mmol/L; 2 hours after administrating glucose ≥ 11.1 mmol/L. Risk factor of smoking defined as more than 10 smokes every day in the last year or last several years. Wile, drinking defined as more than twice every weak. Hyperlipemia was measured for twice at least. Main outcome measures TOAST typing and risk factors. Results All 64 accepted patients were involved in the final analysis. ▪ TOAST typing: CA counted for 22%, SA for 33%, CE for 19%, SOE for 16%, and SUE for 11%. Among them, percentage of SA was the highest, and there was statistically significance ( P < 0.01). ▪ Analysis of risk factors: Numbers of smoking and drinking were 19 (43%) and 15 (34%) respectively in the males, which was more than those in the females (0, 0, P < 0.01). In addition, numbers of hypertension was more in the females than those in the males [15 (75%), 20 (45%), P < 0.05]. Conclusion There are different clinical meanings for different ages in young parients according to TOAST subtypes and risk factors.

Adolescent HIV Prevalence, Sexual Risk, and Willingness to Participate in HIV Vaccine Trials

Purpose To determine human immunodeficiency virus (HIV) prevalence, sexual risk behaviors, and attitudes toward HIV vaccine trials among 11–19 year-olds in a peri-urban community near Cape Town, South Africa. Methods We performed HIV antibody testing on oral transudate, and assessed sexual risk behaviors and willingness to participate in HIV vaccine trials using self-administered questionnaires. Results Of the 510 adolescents selected, 356 (73%) participated. The HIV prevalence of the group was 10.6% (95% confidence interval [CI] 7.5–14.4). One-third of adolescents had experienced sexual debut, with a mean age of 14.6 years. Number of lifetime sexual partners was independently associated with HIV infection (odds ratio [OR] = 1.62; 95% CI 1.1–2.3). In a multivariate analysis, increasing age, female gender, and attending school were independently associated with having had sex. The majority of adolescents (79%) were willing to participate in an HIV vaccine trial. Increasing age and length of residence in the community were significantly associated with willingness to participate (OR = 1.19; 95% CI 1.01–1.4 and OR = 1.14; 95% CI 1.03–1.26, respectively). Conclusions The prevalence of HIV and risk behavior among adolescents in this community is high. HIV vaccines are required that target preadolescents. HIV vaccine trials in adolescents in this setting will be facilitated by their willingness to participate.

Snapshots for May 2006

Snapshots for May 2006

Different Positive Predictive Values of Commercially Available Human Immunodeficiency Virus Enzyme-Linked Immunosorbent Assays

We report our findings concerning the positive predictive values (PPVs) of commercially available human immunodeficiency virus (HIV) antibody tests in an evaluation of HIV prevalence in Peru. The specificity of enzyme-linked immunosorbent assays (ELISAs) varies according to multiple factors, including antigen characteristics, avidity of serum antibodies, patient comorbidities, and specimen processing (2-4). Despite high test specificity, our study found significant variability in the PPVs of several commercially available HIV ELISA kits. As part of a large HIV/STD Collaborative Prevention Trial sponsored by the U.S. National Institute of Mental Health (NIMH) and conducted by the NIMH Collaborative HIV/STD Prevention Trial Group, two population-based surveys were performed to evaluate the prevalence of HIV type 1 (HIV-1) infection and sexually transmitted diseases (STDs) in Lima, Peru, and in northern Peru in 2001 and 2003. While the 2001 study (survey 1) evaluated the general population, the 2003 study (survey 2) examined groups at higher risk for infection. Sera were screened by ELISA for antibodies to HIV-1 using Vironostika (bioMerieux, Inc., Durham, NC) and for antibodies to HIV-1/HIV-2 using Genscreen Plus Ag-Ab (Bio-Rad Laboratories, Marnes la Coquette, France) or Genetic Systems (Bio-Rad Laboratories, Hercules, CA). We confirmed ELISA-positive samples by HIV-1 Western blotting using New Lav Blot I (Bio-Rad France) or Genetic Systems (Bio-Rad USA). Due to several reported “indeterminate” results in survey 1 using New Lav Blot I, these samples were retested with Genetic Systems Western blot kit. ELISA-positive samples in survey 2 were confirmed by using only the Genetic Systems Western blot kit. Results from the Genetic Systems assay were used as the gold standard for determining PPVs in subsequent-calculations. The absence of reported cases of HIV-2 in Peru to date obviated the need for HIV-2-specific Western blot analysis. All samples were processed at the U.S. Naval Medical Research Center Detachment (Lima, Peru) by skilled technicians and were subject to rigorous quality control standards. All of the tests used were reported to have a specificity at or close to 99% in manufacturers' trials and in surveys of available tests published by the World Health Organization and the Centers for Disease Control and Prevention (1, 5). The PPV of the Vironostika assay, however, was significantly higher than the PPVs of the Genscreen test in survey 1 (100.0% versus 62.8% [P = 0.001]) and the Genetic Systems test in survey 2 (98.3% versus 85.2% [P = 0.009]) (Table ​(Table1).1). The PPV of the Vironostika assay was statistically comparable in the two surveys despite the lower prevalence of disease in the general population tested in survey 1 (P = 1.000). TABLE 1. Test performance of HIV ELISA and Western blot assays in population-based surveys in Peru in 2000 to 2003 Despite optimal test specificity, our study illustrates the drastic variation in the PPVs of these assays when applied to large-scale HIV testing. Seemingly minor differences in test specificity are amplified when used in population-based studies, even in communities with what is considered a relatively high prevalence of disease. These results emphasize the value of selecting an ELISA according to the characteristics of the testing population and the critical importance of confirming any positive ELISA results by Western blot analysis. (This work was originally presented at the Infectious Disease Society of America 2004 Annual Meeting, Boston, Mass., 30 September to 3 October 2004 [R. Castillo, R. Meza, S. Leon, J. Pajuelo, C. F. Caceres, J. D. Klausner, T. J. Coates, and F. R. Jones, Infect. Dis. Soc. Am. 2004 Annu. Meet. Program Abstr. Book, abstr. 826, 2004].)

Seroreversion in Subjects Receiving Antiretroviral Therapy during Acute/Early HIV Infection

We assessed human immunodeficiency virus (HIV) antibody seroreversion among individuals initiating antiretroviral therapy (ART) during acute/early HIV infection and determined whether seroreversion was associated with loss of cytotoxic T lymphocyte responses. Subjects in a cohort with acute/early HIV infection (<12 months into infection) who initiated ART within 28 days after study entry and maintained HIV type 1 ribonucleic acid levels of < or =500 copies/mL for >24 weeks were selected. Two clinically available second-generation enzyme immunoassays (EIAs) and a confirmatory Western blot were used to screen subjects for antibody reversion. Those with negative screening test results underwent additional antibody testing, including a third-generation EIA, and were assessed for cytotoxic T lymphocyte responses. Of 87 subjects identified, 12 (14%) had negative antibody test results at the start of ART; all 12 had seroconversion, although 1 had seroconversion only on a third-generation EIA. Of the 87 subjects, 6 (7%) had seroreversion on at least 1 EIA antibody assay while receiving ART during a median follow-up of 90 weeks. The only clinical predictor of seroreversion was a low baseline "detuned" (less sensitive) antibody. Cytotoxic T lymphocyte responses to HIV Gag peptides were detected in 4 of 5 subjects with seroreversion who could be tested. All 5 who had seroreversion who stopped ART experienced virologic rebound and antibody evolution. HIV antibody seroconversion on second-generation EIA antibody tests may fail to occur when ART is initiated early. Seroreversion was not uncommon among subjects treated early, although cytotoxic T lymphocyte responses to HIV antigens remained detectable in most subjects. Antibody seroreversion did not indicate viral eradication. A third-generation EIA was the most sensitive test for HIV antibodies.

Evaluation and Diagnostic Usefulness of Domestic and Imported Enzyme-Linked Immunosorbent Assays for Detection of Human Immunodeficiency Virus Type 1 Antibody in India

Diagnosis of human immunodeficiency virus (HIV) infection is important for patient management and prevention of new infections. The number of test kits available for the detection of HIV antibodies is unprecedented. In order to identify appropriate test kits, we evaluated a variety of commercial kits manufactured abroad as well as in India. The plasma and serum specimens (n=264) were collected from individuals attending the Voluntary Counseling and Testing Centre at the YRG Centre for AIDS and Education. The specimens were used to evaluate six commercially available HIV test kits: Enzaids HIV 1+2, HIV-CheX, Murex HIV-1.2.0, Genscreen HIV 1/2 version 2, Vironostika HIV Uni-Form II Ag/Ab, and CombAids RS Advantage. High sensitivities and specificities (>or=99%) were observed for the Enzaids, Murex, Vironostika, and CombAids assays. HIV-CheX showed the highest number of false-positive and false-negative results. The Genscreen test also gave many false positives. The study indicated that the Enzaids, Murex, and Vironostika enzyme-linked immunosorbent assay kits and the CombAids RS Advantage rapid assay could be used to achieve acceptable results for the detection of HIV antibodies. A combination of two tests is recommended to optimize the efficiency of HIV antibody testing algorithms, especially when evaluation with an HIV Western blot confirmatory test is not possible.

Evaluation of the Sensitivity and Specificity of Rapid Human Immunodeficiency Virus (HIV)1 and 2 Test Kits Commonly Used in Nigeria

The sensitivity and specificity of five rapid HIV antibody test kits commonly used in Nigeria were evaluated. The kits were selected based on their high percentage frequency of use as compared to others. A total of 100 EIA HIV-1and RNA HIV-1 positive sera were used as positive gold standard, while 100 EIA HIV-1 and RNA HIV-1 negative sera were used as negative gold standard. The positive gold standard sera were pooled, serially diluted and analysed to determine the sensitivities of the kits. The methods used were strictly as provided by the manufacturers. Of the 100 positive gold standard serum samples used, Immunocomb-II gave false negative results with 10 (Sensitivity = 90%), while HIV-SAV, Hexagon, Determine and SD-Bioline were false negative with 12 specimens, representing 88% sensitivity for each. On the other hand, of the 100 negative gold standard sera, Immunocomb-II gave 6 false positive results (Specificity = 94%), HIV-SAV 12 (Specificity = 88%), Hexagon 2 (Specificity = 98%), Determine 12 (Specificity = 88%), while SD-Bioline had no false positive result (specificity = 100%). In analytical sensitivity, Immunocomb-II detected the highest serum titre of 30 000, making it the most sensitive. Two of the five test kits (Immunocomb and SD-Bioline) demonstrated excellent analytical sensitivity and specificity respectively. The two could be recommended for use as combination test algorithms instead of EIA/Western Blot algorithm, which is time-consuming, expensive and often not technically feasible in a developing country like ours. This study shows that not all the analytical performance indices cited in the literature from the manufacturers of diagnostic kits are necessarily reproducible in end-user laboratories. Key words: sensitivity, specificity, HIV rapid test kits Journal of Medical Laboratory Science Vol.13(1) 2004: 11 - 16

Evaluation of Rapid Prenatal Human Immunodeficiency Virus Testing in Rural Cameroon

Pregnant women (n = 859) in rural Cameroonian prenatal clinics were screened by two rapid human immunodeficiency virus (HIV) antibody tests (rapid tests [RT]) (Determine and Hema-Strip) using either whole blood or plasma. One additional RT (Capillus, HIV-CHEK, or Sero-Card) was used to resolve discordant results. RT results were compared with HIV-1 enzyme immunoassay (EIA) and Western blot (WB) results of matched dried blood spots (DBS) to assess the accuracy of HIV RTs. DBS EIA/WB identified 83 HIV antibody-reactive, 763 HIV antibody-nonreactive, and 13 indeterminate specimens. RT results were evaluated in serial (two consecutive tests) or parallel (two simultaneous tests) testing algorithms. A serial algorithm using Determine and Hema-Strip yielded sensitivity and specificity results of 97.6% and 99.7%, respectively, whereas a parallel RT algorithm using Determine plus a second RT produced a sensitivity and specificity of 100% and 99.7%, respectively. HIV RTs provide excellent alternatives for identifying HIV infection, and their field performance could be monitored using DBS testing strategies.

Detection of Acute Infections during HIV Testing in North Carolina

North Carolina has added nucleic acid amplification testing for the human immunodeficiency virus (HIV) to standard HIV antibody tests to detect persons with acute HIV infection who are viremic but antibody-negative. To determine the effect of nucleic acid amplification testing on the yield and accuracy of HIV detection in public health practice, we conducted a 12-month observational study of methods for state-funded HIV testing. We compared the diagnostic performance of standard HIV antibody tests (i.e., enzyme immunoassay and Western blot analysis) with an algorithm whereby serum samples that yielded negative results on standard antibody tests were tested again with the use of nucleic acid amplification. A surveillance algorithm with repeated sensitive-less-sensitive enzyme immunoassay tests was also evaluated. HIV infection was defined as a confirmed positive result on a nucleic acid amplification test or as HIV antibody seroconversion. Between November 1, 2002, and October 31, 2003, 109,250 persons at risk for HIV infection who had consented to HIV testing presented at state-funded sites. There were 606 HIV-positive results. Established infection, as identified by standard enzyme immunoassay or Western blot analysis, appeared in 583 participants; of these, 107 were identified, with the use of sensitive-less-sensitive enzyme immunoassay tests, as recent infections. A total of 23 acutely infected persons were identified only with the use of the nucleic acid amplification algorithm. With all detectable infections taken into account, the sensitivity of standard antibody testing was 0.962 (95 percent confidence interval, 0.944 to 0.976). There were two false positive results on nucleic acid amplification tests. The specificity and positive predictive value of the algorithm that included nucleic acid amplification testing were greater than 0.999 (95 percent confidence interval, 0.999 to >0.999) and 0.997 (95 percent confidence interval, 0.988 to >0.999), respectively. Of the 23 acute HIV infections, 16 were detected at sexually transmitted disease clinics. Emergency measures for HIV prevention protected 48 sex partners and one fetus from high-risk exposure to HIV. The addition of nucleic acid amplification testing to an HIV testing algorithm significantly increases the identification of cases of infection without impairing the performance of diagnostic testing. The detection of highly contagious, acutely infected persons creates new opportunities for HIV surveillance and prevention.

The characteristics of people requesting HIV antibody tests at public health centers in Japan.

BACKGROUND: The epidemiologic features of those who requested to undergo the human immunodeficiency virus (HIV) antibody test at public health centers in Japan are still ambiguous, although as a group, they are probably at a high risk to be infected.METHODS: Between April 2001 and March 2002, 14,900 persons visited 131 public health centers that cooperated with this study in relation to the HIV antibody tests. A questionnaire was given to 8,972 persons who agreed to participate in the survey and 5,079 (56.6%) returned the form. Excluding those filled out by persons whose true intent in undergoing the test was the diagnosis of hepatitis C, 4,102 questionnaires were analyzed, individual characteristics examined, and first time visitors and repeaters were compared to assess their behavior and the reasons for of undergoing the test.RESULTS: There were 2,515 (61.3%) males and 1,587 (38.7%) females. The largest age group was composed of 25 to 29 year-olds. Repeaters accounted for 27.2% of all the males and 21.3% of all the females. Their main reason for undergoing the test was anxiety about having contracted an HIV infection through sexual contact with a person of the opposite sex. The proportion of those having sexual contact with males was significantly higher among male repeaters (14.1%) than first timers (8.0%). Among females, the proportion of those who had experience of sexual contact with many and unspecified males was significantly higher for repeaters (39.6%) than first timers (27.3%).CONCLUSION: It was evident from this study that repeaters exist among those who seek to be examined for possible contraction of HIV: they are characterized by risk-taking behavior in contracting an HIV infection through sexual contact.

Human immunodeficiency virus retesting during pregnancy: costs and effectiveness in preventing perinatal transmission.

To estimate the incremental societal costs and effectiveness of a second human immunodeficiency virus (HIV) antibody test during the third trimester of pregnancy compared with no second test. We used a decision tree in this cost-effectiveness analysis to model outcomes among pregnant women in high-risk communities and nationwide who received an initial, negative HIV antibody test during the first trimester. The main outcome measure was discounted costs per year of infant life saved. In high-risk communities with estimated HIV incidence of 6.2 per 1000 person-years, a second HIV test compared with no second test would detect 192 infections in women, prevent approximately 37 infant infections, and save 655 infant life-years per 100,000 women tested. Net savings would be 5.2 million US dollars. Applied to an estimated national incidence of.17 per 1000 person-years, a second test would detect 5.3 infections in women, prevent 1.3 infant infections, and save 23.3 infant life-years per 100,000 women tested. Net costs would be 1.06 million US dollars, or 45,708 US dollars for each year of infant life saved. A second test would result in net savings in populations with HIV incidence of 1.2 per 1000 person-years or higher. Health care providers serving women in communities with an HIV incidence of 1 per 1000 person-years or higher should strongly consider implementing a second voluntary universal HIV test during the third trimester. Providers serving lower-risk communities should pilot second testing to assess community-specific costs.

HIV Disease and Aging

HIV Disease and Aging

Human Immunodeficiency Virus Retesting During Pregnancy

In Brief OBJECTIVE To estimate the incremental societal costs and effectiveness of a second human immunodeficiency virus (HIV) antibody test during the third trimester of pregnancy compared with no second test. METHODS We used a decision tree in this cost-effectiveness analysis to model outcomes among pregnant women in high-risk communities and nationwide who received an initial, negative HIV antibody test during the first trimester. The main outcome measure was discounted costs per year of infant life saved. RESULTS In high-risk communities with estimated HIV incidence of 6.2 per 1000 person-years, a second HIV test compared with no second test would detect 192 infections in women, prevent approximately 37 infant infections, and save 655 infant life-years per 100,000 women tested. Net savings would be $5.2 million. Applied to an estimated national incidence of .17 per 1000 person-years, a second test would detect 5.3 infections in women, prevent 1.3 infant infections, and save 23.3 infant life-years per 100,000 women tested. Net costs would be $1.06 million, or $45,708 for each year of infant life saved. A second test would result in net savings in populations with HIV incidence of 1.2 per 1000 person-years or higher. CONCLUSION Health care providers serving women in communities with an HIV incidence of 1 per 1000 person-years or higher should strongly consider implementing a second voluntary universal HIV test during the third trimester. Providers serving lower-risk communities should pilot second testing to assess community-specific costs. Health care providers serving women at high risk for human immunodeficiency virus should strongly consider implementing a secondvoluntary universal human immunodeficiency virus test during the third trimester of pregnancy.