HIV diagnostic algorithm requires confirmatory testing for initial indeterminate or positive screens in the first week of life.-猫眼课题宝

DOI：

10.1097/qad.0000000000002532

发表时间：

2020-06-01

期刊：

AIDS (London, England)

影响因子：

通讯作者：

中科院分区：

其他

文献类型：

作者：

Ajibola G;Moyo S;Mohammed T;Moseki S;Jack D;Sakoi M;Batlang O;Maswabi K;Bennett K;Hughes MD;Lockman S;Makhema JM;Lichterfeld M;Kuritzkes DR;Shapiro RL

来源链接：

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773540/

Risk for non-diagnostic and false positive HIV testing has not been quantified for neonates. From April 2015-July 2018, we screened HIV-exposed infants in Botswana <96 hours from birth by qualitative DNA PCR. Repeat blood draws for DNA and RNA PCR testing occurred for initial positive and indeterminate results to establish final diagnosis. We compared screening DNA PCR cycle threshold (Ct) values with final HIV status of the child. Of 10,622 HIV-exposed infants, 10,549 (99.3%) had no HIV DNA detected (negative), 42 (0.4%) had HIV DNA detected (positive), and 31 (0.3%) tested indeterminate at first HIV screen. Repeat testing identified 2 (5.0%) of 40 positive screens (2 declined additional testing) as false positives and confirmed 2 (6.5%) of 31 indeterminate screens as infected. Median Ct value at screening was 28.1 (IQR 19.8, 34.8) for children with final positive status, and 35.5 (IQR 32.8, 41.4) for indeterminates who were ultimately negative. Six (15%) of 40 infants with final positive status had Ct value >33 at first screen, while 3 (9.7%) of 31 indeterminates with final negative status had Ct value ≤33 at first screen. This threshold resulted in a negative predictive value of 82% and a positive predictive value of 92% for a single screen. Although a DNA PCR Ct threshold of 33 was predictive of the final HIV status in newborns, overlap occurred for true positives, false positives, and initial indeterminates. Testing additional samples should be standard practice for positive and indeterminate HIV DNA PCR tests in the first week of life.