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Published on: March 30, 2014
Rethinking HIV antibody testing in children aged 18-24 months in the OPPTIM study conducted in Johannesburg, South
Lee Fairlie1, Shobna Sawry1, Jean Le Roux1
1Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.
Insights
HIV antibody tests can remain reactive in uninfected children up to 24 months. Utilizing a three-test algorithm including HIV polymerase chain reaction (PCR) testing can reduce misdiagnosis in HIV-exposed infants.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Diagnostic Testing
Background:
- HIV polymerase chain reaction (PCR) testing is recommended for children under 18 months.
- HIV antibody testing is recommended for children 18 months and older.
- Maternal antibody persistence can affect HIV testing accuracy in infants.
Purpose of the Study:
- To describe seroreversion at various time points in HIV-exposed, uninfected children.
- To evaluate the accuracy of different HIV testing methods in young children.
- To assess the impact of maternal antibodies on HIV test results.
Main Methods:
- Mother-child pairs were enrolled in the OPPTIM study.
- Children were tested using three rapid diagnostic tests (RDTs) and a point-of-care (POC) PCR test.
- HIV ELISA was performed, and antibody testing followed the South African two-test algorithm.
Main Results:
- All children tested PCR-negative.
- Determine RDT remained reactive in 50% of children at 12 months.
- Antibody tests were reactive between 18 and 24 months in 24.5% of children, leading to a 3.3% misdiagnosis rate with the two-test algorithm.
Conclusions:
- HIV antibody tests remained reactive in approximately 25% of children at 18 months and older.
- A three-test algorithm, incorporating HIV-PCR, can reduce misdiagnosis in children aged 18-24 months.
Background:
HIV polymerase chain reaction (PCR) testing is recommended for children <18 months, and HIV antibody testing ≥18 months, limited by maternal antibody persistence. We describe seroreversion at various time points in HIV-exposed, uninfected children.
Methods:
Mother-child pairs were enrolled in the "OPPTIM" study at the child's 6, 10, or 14-week clinic visit, with study visits conducted 4 July 2018 to 27 March 2021. At enrolment, 6-, 9-, 12-, 18-, 21- and 24-months, trained study staff tested children using three RDTs (DetermineTM, Uni-GoldTM and INSTI®) and a point-of-care(POC) Cepheid GeneXpert PCR test using whole blood. Abbott HIV ELISA was performed in children testing RDT non-reactive on 2 tests before 18-months, and at 18-, 21-, and 24-months. Antibody testing was performed according to the South African two-test algorithm, with RDT reactivity reported at each visit per test. Sensitivity and specificity of each test compared to HIV ELISA was assessed between 18- and 24-months.
Results:
In the study, 403 HIV-uninfected children were enrolled; 143(35.5%), 200(49.6%) and 60(14.9%) at 6-, 10- and 14- weeks. All children tested PCR-negative at each visit timepoint. Determine RDT remained reactive in 50% of children at 12-months. In 60/245 (24.5%) children, antibody tests were reactive between 18- and 24-months. Using the South African two-test antibody algorithm, 8/245(3.3%) would have been misdiagnosed with HIV (specificity 96.7%).
Conclusions:
HIV antibody tests remained reactive at ≥18 months in about 25% of children. A three-test algorithm, including the use of an HIV-PCR test, will reduce misdiagnosis of HIV between 18- and 24-months.
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