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Primary HIV-1 infection among infants in sub-Saharan Africa: HPTN 024
Jennifer S Read1, Anthony Mwatha, Barbra Richardson
1Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-7510, USA. jennifer_read@nih.gov
Insights
Clinical signs like cough and diarrhea were common in infants with primary HIV-1 infection, but had low sensitivity for diagnosis. Early laboratory testing is crucial for accurate infant HIV diagnosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Primary Human Immunodeficiency Virus type 1 (HIV-1) infection in infants presents diagnostic challenges.
- Early diagnosis is critical for timely intervention and improved outcomes in vertically infected infants.
Purpose of the Study:
- To assess clinical signs and diagnoses associated with primary HIV-1 infection in infants.
- To evaluate the diagnostic utility of common clinical indicators during early infant HIV infection.
Main Methods:
- Analysis of data from the HIV Prevention Trials Network Protocol 024 clinical trial in sub-Saharan Africa.
- Inclusion of live-born, singleton, first-born infants of HIV-1-infected mothers.
- Follow-up visits from birth to 12 months, with specific focus on infants who acquired HIV-1 postnatally.
Main Results:
- Of 1317 HIV-1-exposed infants, 84 acquired HIV-1 after 4-6 weeks.
- Common signs included cough and diarrhea; common diagnoses were malaria and pneumonia.
- Primary HIV-1 infection showed increased odds of diarrhea (OR=2.4), pneumonia (OR=3.5), otitis media (OR=3.1), and oral thrush (OR=2.9).
- Clinical signs had low sensitivity (1%-16.7%) but high specificity (88.2%-99%) for primary infection.
Conclusions:
- While certain clinical signs are more frequent during primary HIV-1 infection, their low sensitivity limits their standalone diagnostic value.
- High specificity of these signs warrants consideration in clinical assessment.
- Emphasis should be placed on expanding access to laboratory assays for definitive diagnosis of primary HIV-1 infection in infants.
Objectives:
Our objectives were to assess clinical signs and diagnoses associated with primary HIV-1 infection among infants.
Methods:
We analyzed data from a clinical trial (HIV Prevention Trials Network Protocol 024) in sub-Saharan Africa. Study visits were conducted at birth, at 4-6 weeks, and at 3, 6, 9, and 12 months. The study population comprised live born, singleton, first-born infants of HIV-1-infected women with negative HIV-1 RNA assays who were still breastfeeding at 4-6 weeks.
Results:
Of 1317 HIV-1-exposed infants, 84 became HIV-1 infected after 4-6 weeks and 1233 remained uninfected. There were 102 primary and 5650 nonprimary infection visits. The most common signs were cough and diarrhea, and the most common diagnoses were malaria and pneumonia. Primary infection was associated with significantly increased odds of diarrhea [odds ratio (OR) = 2.4], pneumonia (OR = 3.5), otitis media (OR = 3.1), and oral thrush (OR = 2.9). For the clinical signs and diagnoses evaluated, sensitivity was low (1%-16.7%) and specificity was high (88.2%-99%). Positive predictive values ranged from 0.1%-1.4%. Negative predictive values ranged from 28.0%-51.1%.
Conclusions:
Certain clinical signs and diagnoses, although more common during primary HIV-1 infection, had low sensitivity and high specificity. Efforts to expand access to laboratory assays for the diagnosis of primary HIV-1 infection among infants of HIV-1-infected women should be emphasized.
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