Feasibility of a targeted, very early infant HIV diagnosis algorithm in a resource-limited setting

Maritz, Jean; Zyl, Gert van; Mellors, John W.; Theron, Gerhardus Barnard; Nachega, Jean B.; Rabie, Helena; Holgate, Sandi; Preiser, Wolfgang; Bester, Mary Estelle; Cotton, Mark

doi:10.1016/j.ijid.2014.03.695

Cited by 2 publications

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“…Indeterminate samples were repeated until HIV diagnosis confirmation. 26,27 Inclusion criteria were the following: birth weight > 2000 g, commencing ART < 6 weeks of age and no infant cytomegalovirus (CMV) infection. Mothers or legal guardians were consented in person in their language of choice according to Good Clinical Practice standards.…”

Section: Research Methods and Designmentioning

confidence: 99%

Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life

Laughton¹,

Naidoo²,

Dobbels³

et al. 2019

South. Afr. j. HIV med.

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BackgroundAntiretroviral therapy (ART) started between 7 and 12 weeks of age improves neurodevelopmental outcomes in HIV-infected (HIV+) infants, but the impact of even earlier initiation is not yet described.ObjectivesWe assessed the early neurodevelopment of HIV+ infants who started ART within 21 days of life.MethodParticipants were enrolled from the public sector birth HIV-diagnosis programme. Inclusion criteria included the following: birth weight > 2000 g, infant commencing ART < 6 weeks and no infant cytomegalovirus disease. Antiretroviral therapy included Zidovudine/Lamivudine/Nevirapine for the first 2 weeks, the latter then replaced by Lopinavir/Ritonavir. Once body weight > 3 kg and gestational age > 44 weeks, Abacavir replaced Zidovudine. The Griffiths mental development scales (GMDS) were administered at 10–12 months.ResultsOf 29 infants assessed, 23 (79%) were girls. Mean birth weight was 3002 ± 501 g. Twenty-four mothers (83%) received ART during pregnancy. Seven (24%) infants were diagnosed HIV+ within 48 h of birth. Median [interquartile range] viral load (VL) at diagnosis was 3904 [259–16 922] copies/mL, age starting ART was 6.0 [3–10] days and age at VL suppression was 19.1 [15–36] weeks. At the GMDS assessment, nine (31%) participants had detectable VL and 26 (90%) had World Health Organization (WHO) clinical stage I disease. The GMDS was performed at a mean age of 11.5 ± 0.8 months. Mean quotients were within the average range: Global Griffiths score was 103.6 ± 10.9 and mean quotients on the subscales ranged from lowest 95.9 ± 13.4 for locomotor to highest 112.8 ± 11.3 for hearing-and-language.ConclusionPreliminary findings in this small group suggest that early neurodevelopmental scores are within the normal range in infants with perinatal HIV infection who started ART at a median of 6 days.

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Section: Research Methods and Designmentioning

confidence: 99%

Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life

Laughton¹,

Naidoo²,

Dobbels³

et al. 2019

South. Afr. j. HIV med.

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Point-of-care tests detecting HIV nucleic acids for diagnosis of HIV-1 or HIV-2 infection in infants and children aged 18 months or less

Ochodo

Guleid

Deeks

et al. 2021

Cochrane Database of Systematic Reviews

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Background The standard method of diagnosing HIV in infants and children less than 18 months is with a nucleic acid amplification test reverse transcriptase polymerase chain reaction test (NAT RT‐PCR) detecting viral ribonucleic acid (RNA). Laboratory testing using the RT‐PCR platform for HIV infection is limited by poor access, logistical support, and delays in relaying test results and initiating therapy in low‐resource settings. The use of rapid diagnostic tests at or near the point‐of‐care (POC) can increase access to early diagnosis of HIV infection in infants and children less than 18 months of age and timely initiation of antiretroviral therapy (ART). Objectives To summarize the diagnostic accuracy of point‐of‐care nucleic acid‐based testing (POC NAT) to detect HIV‐1/HIV‐2 infection in infants and children aged 18 months or less exposed to HIV infection. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (until 2 February 2021), MEDLINE and Embase (until 1 February 2021), and LILACS and Web of Science (until 2 February 2021) with no language or publication status restriction. We also searched conference websites and clinical trial registries, tracked reference lists of included studies and relevant systematic reviews, and consulted experts for potentially eligible studies. Selection criteria We defined POC tests as rapid diagnostic tests conducted at or near the patient site. We included any primary study that compared the results of a POC NAT to a reference standard of laboratory NAT RT‐PCR or total nucleic acid testing to detect the presence or absence of HIV infection denoted by HIV viral nucleic acids in infants and children aged 18 months or less who were exposed to HIV‐1/HIV‐2 infection. We included cross‐sectional, prospective, and retrospective study designs and those that provided sufficient data to create the 2 × 2 table to calculate sensitivity and specificity. We excluded diagnostic case control studies with healthy controls. Data collection and analysis We extracted information on study characteristics using a pretested standardized data extraction form. We used the QUADAS‐2 (Quality Assessment of Diagnostic Accuracy Studies) tool to assess the risk of bias and applicability concerns of the included studies. Two review authors independently selected and assessed the included studies, resolving any disagreements by consensus. The unit of analysis was the participant. We first conducted preliminary exploratory analyses by plotting estimates of sensitivity and specificity from each study on forest plots and in receiver operating characteristic (ROC) space. For the overall meta‐analyses, we pooled estimates of sensitivity and specificity using the bivariate meta‐analysis model at a common threshold (presence or absence of infection). Main results We identified a total of 12 studies (...

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Feasibility of a targeted, very early infant HIV diagnosis algorithm in a resource-limited setting

Cited by 2 publications

References 0 publications

Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life

Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life

Point-of-care tests detecting HIV nucleic acids for diagnosis of HIV-1 or HIV-2 infection in infants and children aged 18 months or less

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