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Author Notes:

Corresponding author: Anjuli Wagner, Department of Global Health, University of Washington, Box 359909, Seattle, WA 98104, USA, anjuliw@uw.edu, 978 460 2331 (US), +254 712 242 619 (Kenya).

The authors thank the PUSH study participants and their families, without who this research would not be possible.

We thank the PUSH administrative, clinical, and data team for their dedication and support.

We thank Dr. Bhavna Chohan's lab and Mr. Brian Khasimwa for performing HIV PCR tests and CBios tests.

We thank members of the Kizazi Working Group, UW Global Center for Integrated Health of Women, Adolescents and Children (Global WACh), Grace John-Stewart's pre/postdoctoral mentorship group, and Kenya Research & Training Center (KRTC) for their support during the preparation of this article.

Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

The funding sources were not involved in the analyses or interpretation of data.

None of the authors was paid to write this article by a pharmaceutical company or other agency.

Partial data presented previously at AIDS meeting in Durban, South Africa, #TUPEB079, July 18-22, 2016.

Subjects:

Research Funding:

This research was funded by R01-HD023412, K24-HD054314 (PI for both: GJS), and K12 HD000850 (LMC) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), F31MH099988 from NIMH and F32HD088204 from NICHD and R25 TW009345 from FIC (ADW).

This publication was also supported in part by the University of Washington CFAR (P30 AI027757), REDCap UL1TR000423 from NCRR/NIH, the UW Global Center for Integrated Health of Women, Adolescents and Children (Global WACh), and the Pediatric Scientist Development Program (PSDP) through grants from the American Academy of Pediatrics and American Pediatric Society (LMC) and the Fogarty International Center of the National Institutes of Health (D43TW009783 to INN).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • Virology
  • Africa
  • antiretroviral therapy
  • healthcare
  • HIV diagnostic tests
  • pediatrics
  • prevention of mother-to-child transmission/vertical transmission
  • seroprevalence
  • INFECTION
  • DIAGNOSIS
  • MORTALITY
  • MOTHERS
  • BLOOD
  • BORN

Infant/child rapid serology tests fail to reliably assess HIV exposure among sick hospitalized infants

Tools:

Journal Title:

AIDS

Volume:

Volume 31, Number 11

Publisher:

, Pages F1-F7

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background: The WHO guidelines for infant and child HIV diagnosis recommend the use of maternal serology to determine child exposure status in ages 0-18 months, but suggest that infant serology can reliably be used to determine exposure for those less than 4 months. There is little evidence about the performance of these recommendations among hospitalized sick infants and children. Methods: Within a clinical trial (NCT02063880) in Kenya, among children 18 months or younger, maternal and child rapid serologic HIV tests were performed in tandem. Dried blood spots were tested using HIV DNA PCR for all children whose mothers were seropositive, irrespective of child serostatus. We characterized the performance of infant/child serology results to detect HIV exposure in three age groups: 0-3, 4-8, and 9-18 months. Results: Among 65 maternal serology positive infants age 0-3 months, 48 (74%), 1 (2%) and 16 (25%) had positive, indeterminate and negative infant serology results, respectively. Twelve (25%), 0 and 4 (25%) of those with positive, indeterminate and negative infant serology results, respectively, were HIV-infected by DNA PCR. Among 71 maternal serology positive infants age 4-8 months, 31 (44%), 8 (11%) and 32 (45%) had positive, indeterminate and negative infant serology results, respectively. Fourteen (45%), 2 (25%) and 7 (22%) infants with positive, indeterminate and negative infant serology results, respectively, were HIV-infected. Among 67 maternal serology positive infants/children age 9-18 months, 40 (60%), 2 (3%) and 25 (37%) had positive, indeterminate and negative infant serology results, respectively. Thirty-six (90%), 2 (100%) and 2 (8%) infants with positive, indeterminate and negative infant serology results, respectively, were HIV-infected. In the 0-3, 4-8 and 9-18 month age groups, use of maternal serology to define HIV exposure identified 33% [95% confidence interval (CI) 10-65%], 44% (95% CI 20-70%) and 5% (95% CI 0.1-18%) more HIV infections, respectively. Conclusion: Maternal serology should preferentially be used for screening among hospitalized infants of all ages to improve early diagnosis of children with HIV.

Copyright information:

© 2017 Wolters Kluwer Health, Inc.

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