Rapid Serological Tests Ineffectively Screen for HIV Exposure in HIV-Positive Infants.
Rapid Serological Tests Ineffectively Screen for HIV Exposure in HIV-Positive Infants.
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快速血清学检测无法有效筛查 HIV 阳性婴儿的 HIV 暴露情况。
DOI：
10.1097/qai.0000000000001609
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Kiyaga,Char
中科院分区：
文献类型：
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作者：
Urick,Brittany;Fong,Youyi;Okiira,Christopher;Nabukeera-Barungi,Nicolette;Nansera,Denis;Ochola,Emmanuel;Nteziyaremye,Julius;Bigira,Victor;Ssewanyana,Isaac;Olupot-Olupot,Peter;Peter,Trevor;Ghadrshenas,Anisa;Vojnov,Lara;Kiyaga,Char
背景：关于婴儿快速血清学检测确定HIV暴露的性能和效用的数据尚不清楚，在某些情况下相互矛盾。本研究旨在了解快速血清学检测在高HIV负担、高Option B+覆盖率环境中的性能，以作为HIV暴露筛查工具。方法：在乌干达4家地区医院系统招募了3600名24个月以下的婴儿，同时使用HIV快速血清学和核酸检测进行检测。结果：94名接受快速血清学和核酸检测的HIV阳性婴儿中，只有58名快速血清学检测呈阳性（灵敏度：61.7%; 95%置信区间：51.1至71.5）。使用快速血清学检测筛查婴儿是否暴露于艾滋病毒和后续核酸检测将错过38.3%（94名中的36名）艾滋病毒阳性婴儿。最后，几名经快速血清学检测呈阴性的艾滋病毒阳性婴儿被送到健康儿童入境点，被认为是健康的。所有3个艾滋病毒阳性的婴儿提出推广和免疫接种是阴性的快速血清学检测和73%（8 11）呈现outline.Conclusions：这些数据表明，使用快速血清学检测可能有不足的性能作为一个指标的暴露和潜在的艾滋病毒感染的婴儿在两个良好的儿童（免疫和社区推广）和患病婴儿（营养和住院）的入口点。为了更好地识别艾滋病毒阳性婴儿，应考虑对18个月以下的婴儿进行核酸检测。
Background:Data on the performance and utility of rapid serological tests in infants to determine HIV exposure are unclear and in some instances contradictory. This study sought to understand the performance of rapid serological tests in high HIV burden, high Option B+ coverage settings to be used as an HIV exposure screening tool.Methods:A total of 3600 infants up to 24 months of age at 4 regional hospitals in Uganda were systematically enrolled and tested simultaneously using both HIV rapid serological and nucleic acid–based tests.Results:Only 58 of the 94 HIV-positive infants who received both rapid serological and nucleic acid–based tests were positive with the rapid serological test (sensitivity: 61.7%; 95% confidence interval: 51.1 to 71.5). Using rapid serological tests to screen infants for exposure to HIV and follow-up nucleic acid-based testing would have missed 38.3%(36 of 94) of HIV-positive infants. Finally, several HIV-positive infants who were negative by rapid serological test presented to well-child entry points and were considered healthy. All 3 HIV-positive infants presenting to outreach and immunization were negative by rapid serological testing and 73%(8 of 11) presenting to outpatient.Conclusions:These data suggest that the use of rapid serological tests may have inadequate performance as an indicator of exposure and potential HIV infection among infants presenting at both well-child (immunization and community outreach) and sick-infant (nutrition and inpatient) entry points. To improve the identification of HIV-positive infants, nucleic acid–based testing should instead be considered in infants aged younger than 18 months.