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Early detection of perinatal human immunodeficiency virus (HIV) type 1 infection using HIV RNA amplification and
R W Steketee1, E J Abrams, D M Thea
1Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Insights
Early detection of perinatal HIV infection is crucial. Plasma HIV RNA tests identify more infected infants sooner than DNA-PCR, enabling timely interventions for better outcomes.
Area of Science:
- Virology
- Pediatric Infectious Diseases
- Molecular Diagnostics
Background:
- Early diagnosis of perinatally transmitted human immunodeficiency virus type 1 (HIV) infection is critical for initiating timely interventions.
- Conventional methods like HIV coculture and DNA polymerase chain reaction (DNA-PCR) have limitations in detecting HIV in newborns.
- Extracellular HIV RNA may be present earlier in infection than detectable DNA, suggesting its potential as an early diagnostic marker.
Purpose of the Study:
- To compare the efficacy of plasma HIV RNA assays versus DNA-PCR for the early detection of perinatally acquired HIV infection in infants.
- To evaluate the sensitivity and timeliness of HIV RNA detection compared to DNA-PCR in neonates and young infants.
Main Methods:
- A study was conducted involving 108 blood specimens from 49 HIV-infected infants and 10 specimens from 8 uninfected infants.
- Specimens were tested simultaneously using plasma HIV RNA assays and DNA-PCR.
- Infant age at specimen collection ranged from birth to 3 months.
Main Results:
- In infants less than 28 days old, HIV RNA positivity was 56% compared to 33% for DNA-PCR (P = .001).
- In specimens collected after 14 days of age (n=81), HIV RNA testing yielded a 98% positivity rate.
- No HIV-infected infants tested DNA-PCR positive and HIV RNA negative; all uninfected infants tested HIV RNA negative.
Conclusions:
- Plasma HIV RNA assays demonstrate earlier and more reliable detection of perinatal HIV infection compared to HIV DNA-PCR.
- HIV RNA testing shows promise as a superior diagnostic tool for early identification of HIV in newborns.
- Earlier detection via HIV RNA assays can facilitate prompt initiation of treatment and improve infant health outcomes.
Abstract:
Early diagnosis of perinatally transmitted human immunodeficiency virus type 1 (HIV) infection can guide early interventions. HIV coculture and DNA polymerase chain reaction (DNA-PCR) detect few HIV-infected infants at birth and 90%-100% by age 3 months. Because extracellular HIV RNA may appear soon after infection, a plasma HIV RNA assay was compared with DNA-PCR for early detection of perinatally infected infants. Blood-draw specimens (108) obtained at the same time from 49 HIV-infected infants and 10 specimens from 8 uninfected infants were tested. HIV RNA and DNA-PCR positivity rates were 56% and 33%, respectively, in 36 specimens from 36 infants <28 days of age (binomial test, P = .001). Among 81 specimens obtained after age 14 days, 79 (98%) were positive by HIV RNA testing. No HIV-infected infant specimens were DNA-PCR-positive and HIV RNA-negative. All specimens from 8 uninfected infants were HIV RNA-negative. These results suggest that plasma HIV RNA was detectable earlier and more reliably than HIV DNA in perinatal infection.