PURPOSE OF THE STUDY.
The identification of HIV-derived nucleic acid in the blood of perinatally exposed infants is the most sensitive and specific method for the early detection of HIV infection in this population. HIV DNA is measured in peripheral blood mononuclear cells and HIV RNA in the plasma. This study compares the performance of HIV DNA polymerase chain reaction (PCR) and HIV RNA PCR for the diagnosis of HIV infection in exposed infants.
A total of 1567 children, representing a subgroup born to HIV-infected women, were enrolled in a prospective, multicenter, French perinatal cohort.
Plasma HIV RNA and peripheral blood mononuclear cell HIV DNA were measured by using standard assays generally obtained at birth and then at 1, 3, and 6 months of age in the absence of breastfeeding.
A total of 1502 infants were considered uninfected at 6 months of age, and 65 were considered infected. The following table demonstrates the ability of the 2 assays to identify infection in these 65 patients.
Neither maternal antiretroviral therapy nor postnatal prophylaxis affected PCR results at <7 days and at 3 months of age. It is important to note that these mothers were undergoing regimens that were not fully suppressive, and 50 of the 65 patients were not receiving highly active antiretroviral therapy consisting of at least 3 drugs. DNA PCR and RNA PCR resulted in equal sensitivity. DNA PCR was associated with 2 false-positive results at 3 and 4 days of age. The positive predictive value at <7 days of age was 100% for HIV RNA PCR and 78% for DNA PCR; at 1 month of age, both tests had positive predictive values of 100%. Negative predictive values for both tests were 99.5% at <7 days, 99.8% at 1 month, and 100% at 3 months of age.
Both HIV DNA PCR and HIV RNA PCR resulted in similar sensitivities and specificities at 1 and 3 months of age. Importantly, 11% of infected children had negative PCR results at age 1 month regardless of assay used.
Both assays seem to be equally effective in identifying HIV infection in infants exposed perinatally to HIV. In general, reference laboratories are more familiar with RNA PCR. This situation would be the primary justification for use of RNA PCR in the community.
- Copyright © 2012 by the American Academy of Pediatrics