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Rational testing of the HIV-exposed infant.

D K Benjamin1, W C Miller, S A Fiscus

  • 1Duke University Medical Center, Department of Pediatrics, Durham, North Carolina, USA.

Pediatrics
|July 4, 2001
PubMed
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Evaluating human immunodeficiency virus (HIV) testing for infants shows that three negative DNA PCR tests make ELISA follow-up costly and often unnecessary. Documentation of seroreversion is better in specialized clinics.

Area of Science:

  • Pediatric Infectious Diseases
  • Virology
  • Clinical Diagnostics

Background:

  • Infant human immunodeficiency virus (HIV) diagnosis relies on timely and accurate testing.
  • Enzyme-linked immunosorbent assay (ELISA) is a common method for HIV antibody detection, but its utility in HIV-exposed infants requires evaluation.
  • DNA polymerase chain reaction (PCR) offers early detection of HIV infection.

Purpose of the Study:

  • To assess the effectiveness of different human immunodeficiency virus (HIV) testing strategies for exposed infants.
  • To determine the optimal follow-up protocols using enzyme-linked immunosorbent assay (ELISA) testing.
  • To analyze the cost-effectiveness of diagnostic approaches for HIV-exposed infants.

Main Methods:

  • Retrospective review of 742 HIV-exposed infants' data from North Carolina.

Related Experiment Videos

  • Analysis of 2474 DNA polymerase chain reaction (PCR) tests performed at the University of North Carolina Retrovirology Core Laboratory.
  • Evaluation of enzyme-linked immunosorbent assay (ELISA) testing utility and costs for infants at Duke University Pediatric Infectious Disease Clinic (1993-1998).

    • Main Results:

    • DNA PCR demonstrated high sensitivity (87.1%) and specificity (99.9%).
    • Among 224 HIV-exposed infants with at least 3 negative diagnostic tests (DNA PCR or HIV blood culture), all 178 who had ELISA testing showed seroreversion.
    • Documentation of seroreversion was significantly higher in infants managed at Duke's subspecialty clinic (158/159) compared to those transferred to primary care (20/65).

    Conclusions:

    • Three negative DNA PCR tests indicate a low probability of HIV infection, making subsequent ELISA testing potentially resource-intensive.
    • Multidisciplinary clinics facilitate better documentation of seroreversion in HIV-exposed infants.
    • Routine ELISA follow-up after multiple negative PCR tests may not be a cost-effective use of medical resources.