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Infant/child rapid serology tests fail to reliably assess HIV exposure among sick hospitalized infants
Anjuli D Wagner1, Irene N Njuguna, Ruth A Andere
1aDepartment of Global Health, University of Washington, Seattle, Washington, USA bKenyatta National Hospital, Nairobi, Kenya cDepartment of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA dDepartment of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya eDepartment of Medicine, University of Washington, Seattle, Washington, USA fKenya Medical Research Institute, Nairobi, Nairobi, Kenya gDepartment of Epidemiology hDepartment of Pediatrics, University of Washington, Seattle, Washington, USA. *Anjuli D. Wagner and Irene N. Njuguna are co-first authors.
Insights
Maternal serology is recommended for screening hospitalized infants for HIV, improving early diagnosis. This approach is more effective than infant serology in identifying HIV infections across all age groups.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- World Health Organization (WHO) guidelines recommend maternal serology for infant HIV exposure assessment up to 18 months.
- Infant serology is considered reliable for exposure determination in infants under 4 months.
- Limited evidence exists on the performance of these WHO guidelines for hospitalized, sick infants and children.
Purpose of the Study:
- To evaluate the performance of maternal and infant serology for HIV diagnosis in hospitalized infants and children.
- To compare the effectiveness of maternal serology versus infant serology in detecting HIV exposure across different age groups (0-3, 4-8, and 9-18 months).
Main Methods:
- A clinical trial (NCT02063880) in Kenya enrolled children 18 months or younger.
- Maternal and child rapid serologic HIV tests were conducted simultaneously.
- Dried blood spots were tested using HIV DNA PCR for infants born to seropositive mothers.
Main Results:
- In infants aged 0-3 months, maternal serology identified 33% more HIV infections compared to infant serology.
- In infants aged 4-8 months, maternal serology identified 44% more HIV infections.
- In children aged 9-18 months, maternal serology identified 5% more HIV infections.
Conclusions:
- Maternal serology is a preferred screening method for hospitalized infants of all ages.
- Utilizing maternal serology can enhance the early diagnosis of HIV in children.
- The study highlights the importance of maternal serology in improving HIV detection rates in vulnerable infant populations.
Background:
The WHO guidelines for infant and child HIV diagnosis recommend the use of maternal serology to determine child exposure status in ages 0-18 months, but suggest that infant serology can reliably be used to determine exposure for those less than 4 months. There is little evidence about the performance of these recommendations among hospitalized sick infants and children.
Methods:
Within a clinical trial (NCT02063880) in Kenya, among children 18 months or younger, maternal and child rapid serologic HIV tests were performed in tandem. Dried blood spots were tested using HIV DNA PCR for all children whose mothers were seropositive, irrespective of child serostatus. We characterized the performance of infant/child serology results to detect HIV exposure in three age groups: 0-3, 4-8, and 9-18 months.
Results:
Among 65 maternal serology positive infants age 0-3 months, 48 (74%), 1 (2%) and 16 (25%) had positive, indeterminate and negative infant serology results, respectively. Twelve (25%), 0 and 4 (25%) of those with positive, indeterminate and negative infant serology results, respectively, were HIV-infected by DNA PCR. Among 71 maternal serology positive infants age 4-8 months, 31 (44%), 8 (11%) and 32 (45%) had positive, indeterminate and negative infant serology results, respectively. Fourteen (45%), 2 (25%) and 7 (22%) infants with positive, indeterminate and negative infant serology results, respectively, were HIV-infected. Among 67 maternal serology positive infants/children age 9-18 months, 40 (60%), 2 (3%) and 25 (37%) had positive, indeterminate and negative infant serology results, respectively. Thirty-six (90%), 2 (100%) and 2 (8%) infants with positive, indeterminate and negative infant serology results, respectively, were HIV-infected. In the 0-3, 4-8 and 9-18 month age groups, use of maternal serology to define HIV exposure identified 33% [95% confidence interval (CI) 10-65%], 44% (95% CI 20-70%) and 5% (95% CI 0.1-18%) more HIV infections, respectively.
Conclusion:
Maternal serology should preferentially be used for screening among hospitalized infants of all ages to improve early diagnosis of children with HIV.
