False-positive HIV DNA PCR testing of infants: Implications in a changing epidemic

To examine false-positive HIV DNA polymerase chain reaction (PCR) test results in children, and the potential implications for the paediatric HIV epidemic in sub-Saharan Africa. A review was done of records over a 6-year period of children less than 18 months old at an HIV treatment site in South Af...

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Bibliographic Details
Published in:South African medical journal 2012-03, Vol.102 (3), p.149-152
Main Authors: FEUCHT, Ute, FORSYTH, Brian, KRUGER, Mariana
Format: Article
Language:English
Subjects:
Africa South of the Sahara - epidemiology
Biological and medical sciences
Children
Diagnosis
Diagnostic Errors - prevention & control
Diagnostic Errors - statistics & numerical data
Disease transmission
Diseases
DNA, Viral - analysis
False Positive Reactions
Female
General aspects
HIV (Viruses)
HIV - genetics
HIV Infections - diagnosis
HIV Infections - epidemiology
HIV Infections - transmission
Human immunodeficiency virus
Human viral diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infant
Infant, Newborn
Infectious Disease Transmission, Vertical - statistics & numerical data
Infectious diseases
Male
Medical sciences
Polymerase chain reaction
Polymerase Chain Reaction - methods
Polymerase Chain Reaction - standards
Practice guidelines (Medicine)
Predictive Value of Tests
Pregnancy
Pregnancy Complications, Infectious - epidemiology
Prevention
RNA, Viral - analysis
Sensitivity and Specificity
Time Factors
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:To examine false-positive HIV DNA polymerase chain reaction (PCR) test results in children, and the potential implications for the paediatric HIV epidemic in sub-Saharan Africa. A review was done of records over a 6-year period of children less than 18 months old at an HIV treatment site in South Africa, to evaluate those with an initial 'false'-positive HIV DNA PCR result, but later proven to be HIV-uninfected with HIV DNA PCR and/or quantitative HIV RNA PCR tests. We calculated the influence of changing HIV transmission rates on predictive values (PV) of HIV DNA PCR tests in a hypothetical population of all HIV-exposed infants over a 1-year period. (Positive PV: proportion of individuals with a positive test with disease; negative PV: proportion of individuals with negative test and no disease). Of 718 children, 40 with an initial positive HIV DNA PCR test were subsequently proven to be HIV-uninfected, resulting in a positive PV of 94.4%. Most (75%) uninfected children had PMTCT interventions and were asymptomatic or mildly symptomatic (77.5%). Calculations using a test specificity of 99.4%, as reported previously, show a decrease in positive PV using a single-test strategy from 98.6% at 30% HIV transmission rate, to 94.8% at 10% transmission, to 62.5% at 1% transmission. Reduction in test specificity further decreases positive PV at low transmission rates. Decreasing mother-to-child HIV transmission rates reduce the positive predictive value of a single HIV DNA PCR test result, necessitating adaptations to diagnostic algorithms to avoid misdiagnosis and inappropriate treatment, especially with early initiation of antiretroviral therapy in asymptomatic infants.
ISSN:0256-9574
DOI:10.7196/SAMJ.4951