How valuable are IgA and IgM anti-HIV tests for the diagnosis of mother-child transmission of HIV in an African setting?

Mokili, John L.; Connell, J.; Parry, John; Green, Stephen D. R.; Davies, Antony G.; Cutting, William A M

doi:10.1016/0928-0197(95)00149-2

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…In the largest of these, positive HIV-specific IgA responses in infant serum were extremely low, ranging from undetectable to less than 0·5% [30,33]. Other smaller studies have detected HIVspecific antibodies in cord blood obtained from uninfected infants born to HIV-infected mothers, which would support low-level diffusion of IgA antibodies; however, this could also represent infant IgA production resulting from HIV-1 exposure in utero, consistent with our current hypothesis [29,31,32].…”

Section: Characteristicsupporting

confidence: 84%

Salivary human immunodeficiency virus (HIV)-1-specific immunoglobulin A in HIV-1-exposed infants in Kenya

Farquhar

VanCott

Bosire

et al. 2008

Clinical and Experimental Immunology

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SummaryHumoral immunity, and specifically immunoglobulin A (IgA) that is directed against human immunodeficiency virus (HIV)-1, may contribute to protection against HIV-1 acquisition at mucosal surfaces. HIV-1-specific IgA has been detected in genital tract secretions of HIV-1-uninfected commercial sex workers with HIV-1 exposure, and may be produced in parotid saliva by infants exposed orally to HIV-1 during delivery and breastfeeding. To explore this hypothesis, we collected saliva from 145 infants aged Յ 6 months enrolled in a perinatal HIV-1 transmission study in Nairobi and from 55 control infants without HIV-1 exposure who were born to HIV-1-seronegative mothers. Among the 145 infants, 115 (79%) remained uninfected during the 12-month study period and 30 (21%) became HIV-1-infected during followup. Nine (8%) of the 115 HIV-1-exposed, uninfected infants had detectable levels of HIV-1 gp160-specific IgA compared with four (13%) of 30 infected infants and none of 55 control infants (P = 0·47 and P = 0·03 respectively). Among the nine HIV-1-exposed, uninfected infants with positive assays, median age was 1 month and none acquired HIV-1 during follow-up. We conclude that HIV-1-specific salivary IgA responses may be generated by very young infants exposed perinatally to maternal HIV-1. Mucosal responses would be an appropriate target for paediatric vaccines against breast milk HIV-1 transmission.

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Section: Characteristicsupporting

confidence: 84%

Salivary human immunodeficiency virus (HIV)-1-specific immunoglobulin A in HIV-1-exposed infants in Kenya

Farquhar

VanCott

Bosire

et al. 2008

Clinical and Experimental Immunology

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“…Since no single method is entirely sensitive or specific when undertaking diagnosis of HIV infection in children younger than the age of 2 years, several independent approaches were used. All specimens were examined for IgG anti-HIV (as outlined in the previous section), for HIV proviral DNA (Roche HIV Amplicor), for HIV p24 antigen by the immune complex dissociation protocol with confirmation by a neutralization assay (HIV-1 p24 Antigen Assay and p24 Antigen Neutralisation Kit; Coulter Corporation), and for IgA and IgM anti-HIV (24). In children younger than 3 months of age, only HIV proviral DNA and p24 antigen are meaningful markers of infection.…”

Section: Methodsmentioning

confidence: 99%

“…The presence of both of these was taken as clear evidence of HIV in the specimen; the presence of only one was taken to indicate probable infection, suggesting a false-negative diagnostic finding in the other, particularly if the clinical history was also consistent with HIV infection. In children ages 3 months or older the presence of IgA anti-HIV (and IgM anti-HIV) has been shown to be very highly predictive of infection (21,24,28,30). Therefore, its presence was considered significant in these children, as was the persistence of IgG anti-HIV beyond 18 months of age.…”

Section: Methodsmentioning

confidence: 99%

Performance of the Amplicor human immunodeficiency virus type 1 PCR and analysis of specimens with false-negative results

et al. 1997

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Over a 4-year period, the Roche Amplicor kit was used in a United Kingdom reference laboratory for the detection or confirmation of human immunodeficiency virus (HIV) type 1 infection, particularly in infants born to HIV-infected mothers. Of 408 specimens from adults and older children tested, the 122 seronegative specimens were all Amplicor negative. Of the 286 seropositive specimens, 268 were Amplicor positive. On the basis of these results, the Amplicor assay has a specificity of 100% and a sensitivity of 93.7%. In addition, for 247 specimens from infants and young children, serological results may not have been diagnostic because of placental transfer of maternal antibodies. Forty-eight were Amplicor positive, and of the 199 Amplicor-negative specimens, 19 were assumed to be false negative on the basis of clinical data, serological markers (including p24 antigen), and/or results for previous or follow-up specimens. This represents a sensitivity of 75% for the Amplicor test for specimens from patients under 2 years of age. Of these 37 false-negative specimens plus 2 specimens from other laboratories, 31 could be characterized by amplifying extracted material from them by an in-house nested gag PCR spanning the Amplicor target region. The amplicons were sequenced and found to represent subtypes A (35.5%), B (22.6%), C (22.6%), D (16.1%), and G (3.2%). False-negative results by the Amplicor assay may be ascribed to low-target copy number, the physical behavior of one primer (SK462), and sequence variation in the target region of the other primer (SK431).

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“…20,22,23 Briefly, Kimpese is a rural town with a population of approximately 30,000 people situated on the main road between Kinshasa (225 km) and the port of Matadi (140 km). The Institut M… dical Evang… lique (IME) is the main reference hospital (450 beds) for this rural area and provides care for people from the surrounding villages and towns.…”

Section: Study Area Patients and Samplesmentioning

confidence: 99%

“…The outcome of mother-to-child transmission of HIV-1 was established in 46 mothers as previously described. 23 To ensure that the region of the gag p17 gene analyzed (330 base pairs; positions 907 to 1236 in the HIV H X B2 genom e) was suitable to classify HIV-1 sequences, a phylogenetic tree was constructed using a data set (330 bp long) of 24 previously published sequences representing subtypes A (U455, K89, 92U G037, VI32), B (RF, HXB2, OYI, JRFL), C (92BR025, ETH220, ZAM18, UG268), D (NDK, Z2Z6, ELI, 94UG114), F (93BR020, VI174, VI69, BZ162), G (92NG003, 92NG083), H (VI557, 90CF056) 25 and 2 sequences provisionally classified as subtype J (SE7022, SE7887). 4 The gag reference sequences for subtype I were not available at the time of this analysis.…”

Section: Resu Ltsmentioning

confidence: 99%

Genetic Heterogeneity of HIV Type 1 Subtypes in Kimpese, Rural Democratic Republic of Congo

Mokili¹,

Wade²,

Burns³

et al. 1999

AIDS Research and Human Retroviruses

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A relatively low and stable seroprevalence of HIV-1 was previously reported among pregnant women attending for antenatal care between 1988 and 1993 in Kimpese, a rural town in the Democratic Republic of Congo (DRC, formerly Zaire). To characterize the HIV-1 subtypes circulating in this area, we have examined a 330-bp fragment of the p17 region of the gag gene of HIV-1 strains obtained from 70 patients (55 mothers, 15 children), of whom 61 were epidemiologically unlinked. Phylogenetic analyses revealed the existence of at least seven HIV-1 subtypes within the Kimpese region. Among the 61 epidemiologically unlinked patients, subtype A was predominant and found in 29 (47.5%) individuals. Other subtypes cocirculating in this rural part of DRC include subtypes C (1.6%), D (9.8%), F (3.2%), G (6.5%), H (21.3%), and J (4.9%). Sequences from four patients did not cluster with any of the currently documented HIV-1 subtypes, in analyses of fragments of both the gag (247 to 330 bp, 197 bp, and 310 bp) and env (340 bp) genes. Overall, comparisons of the gag(p17) gene regions revealed high pairwise divergences (mean, 19.9%; range, 1 to 46%). This level of gag(p17) gene variation in the DRC is considerably greater than previously appreciated. These results are relevant for the molecular epidemiology of HIV-1 in Africa and for the design of a future vaccine against HIV-1 in this region.

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How valuable are IgA and IgM anti-HIV tests for the diagnosis of mother-child transmission of HIV in an African setting?

Cited by 8 publications

References 27 publications

Salivary human immunodeficiency virus (HIV)-1-specific immunoglobulin A in HIV-1-exposed infants in Kenya

Salivary human immunodeficiency virus (HIV)-1-specific immunoglobulin A in HIV-1-exposed infants in Kenya

Performance of the Amplicor human immunodeficiency virus type 1 PCR and analysis of specimens with false-negative results

Genetic Heterogeneity of HIV Type 1 Subtypes in Kimpese, Rural Democratic Republic of Congo

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