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False negative DNA polymerase chain reaction in an infant with subtype C human immunodeficiency virus 1 infection
Nancy E Kline1, Heidi Schwarzwald, Mark W Kline
1Section of Retrovirology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
Insights
Early infant HIV diagnosis using DNA PCR may fail for non-subtype B HIV infections. This case highlights the need for improved diagnostic methods to detect diverse HIV strains in infants.
Area of Science:
- Virology
- Infectious Diseases
- Pediatric Medicine
Background:
- Early infant diagnosis of Human Immunodeficiency Virus (HIV) infection is crucial for timely treatment and improved outcomes.
- Polymerase Chain Reaction (PCR) detection of HIV proviral DNA is a standard diagnostic method in infants.
- Subtype B has historically been the predominant HIV strain in the United States.
Observation:
- A case of an infant infected with non-subtype B (subtype C) HIV presented with repeated negative results from HIV DNA PCR tests.
- The infant was an African American immigrant, suggesting a potential increase in non-subtype B HIV infections in US pediatric populations.
Findings:
- Standard HIV DNA PCR assays may not be adequately optimized or validated for detecting non-subtype B HIV strains.
- This limitation can lead to false-negative results, delaying the diagnosis of HIV infection in infants.
Implications:
- Clinicians managing infants, particularly those with diverse ethnic backgrounds or from regions with non-subtype B prevalence, must be aware of this diagnostic limitation.
- There is a critical need for the development and validation of more robust and broadly reactive HIV DNA PCR assays to ensure accurate early infant diagnosis.
- Failure to detect non-subtype B HIV can have significant consequences for infant health and public health efforts to control HIV transmission.
Abstract:
Diagnosis of HIV infection in early infancy generally relies on detection of HIV proviral DNA by PCR. However, many of the HIV DNA PCR assays currently in use are either not optimized or have not been validated for diagnosis of infection with non-subtype B HIV. We report the case of an HIV-infected African American immigrant infant with subtype C HIV infection who tested negative repeatedly by HIV DNA PCR. Clinicians should be aware of this particular limitation of HIV DNA PCR assays, because it is likely that an increasing proportion of the HIV-infected infants seen in US centers will be infected with non-subtype B HIV.