The use of viral culture and p24 antigen testing to diagnose human immunodeficiency virus infection in neonates

Burgard, Marianne; Mayaux, Marie-Jeanne; Blanche, S.; Ferroni, Agnès; Guihard-Moscato, M-L; Mc, Allemon; Ciraru-Vigneron, N; Firtion, Ghislaine; Floch, Corinne; Guillot, F; Lachassine, Eric; Vial, M C; Griscelli, C; Rouzioux, C; Allisy, C; Armengaud, Didier; Jm, Babinet; P, Balde; Fadel, FB

doi:10.1016/0020-7292(93)90608-y

Cited by 10 publications

(16 citation statements)

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“…The use of viral culture for the diagnosis of HIV-1 infection in infants and young children has been studied extensively. [47][48][49][50][51][52] Although previously considered the gold standard of HIV-1 diagnostic assays for infants and young children, the disadvantages of viral culture (ie, that it is labor intensive, time consuming, costly, and poses a biohazard risk) are now generally considered to outweigh its advantages. HIV-1 culture has limited availability, and its routine use in the clinical care of HIV-1-exposed infants and young children has been supplanted by HIV-1 NAATs.…”

Section: Hiv-1 Culturementioning

confidence: 99%

“…Many studies of p24 antigen for diagnosis of HIV-1 infection have been conducted over the past several years, 49,[76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93] with the sensitivity of the assay increasing with increasingly effective techniques used to dissociate p24 antigen from anti-p24 antibody (immune complex-dissociated p24 antigen detection). 94 In general, p24 antigen assays have been used much less frequently than HIV-1 DNA-or RNA-amplification techniques for diagnosis of HIV-1 infection because of the relatively poor sensitivity of p24 antigen assays and the absence of readily available commercial, FDA-approved reagents.…”

Section: P24 Antigen Assaysmentioning

confidence: 99%

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Diagnosis of HIV-1 Infection in Children Younger Than 18 Months in the United States

Read¹

2007

Pediatrics

118

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The objectives of this technical report are to describe methods of diagnosis of HIV-1 infection in children younger than 18 months in the United States and to review important issues that must be considered by clinicians who care for infants and young children born to HIV-1–infected women. Appropriate HIV-1 diagnostic testing for infants and children younger than 18 months differs from that for older children, adolescents, and adults because of passively transferred maternal HIV-1 antibodies, which may be detectable in the child's bloodstream until 18 months of age. Therefore, routine serologic testing of these infants and young children is generally only informative before the age of 18 months if the test result is negative. Virologic assays, including HIV-1 DNA or RNA assays, represent the gold standard for diagnostic testing of infants and children younger than 18 months. With such testing, the diagnosis of HIV-1 infection (as well as the presumptive exclusion of HIV-1 infection) can be established within the first several weeks of life among nonbreastfed infants. Important factors that must be considered when selecting HIV-1 diagnostic assays for pediatric patients and when choosing the timing of such assays include the age of the child, potential timing of infection of the child, whether the infection status of the child's mother is known or unknown, the antiretroviral exposure history of the mother and of the child, and characteristics of the virus. If the mother's HIV-1 serostatus is unknown, rapid HIV-1 antibody testing of the newborn infant to identify HIV-1 exposure is essential so that antiretroviral prophylaxis can be initiated within the first 12 hours of life if test results are positive. For HIV-1–exposed infants (identified by positive maternal test results or positive antibody results for the infant shortly after birth), it has been recommended that diagnostic testing with HIV-1 DNA or RNA assays be performed within the first 14 days of life, at 1 to 2 months of age, and at 3 to 6 months of age. If any of these test results are positive, repeat testing is recommended to confirm the diagnosis of HIV-1 infection. A diagnosis of HIV-1 infection can be made on the basis of 2 positive HIV-1 DNA or RNA assay results. In nonbreastfeeding children younger than 18 months with no positive HIV-1 virologic test results, presumptive exclusion of HIV-1 infection can be based on 2 negative virologic test results (1 obtained at ≥2 weeks and 1 obtained at ≥4 weeks of age); 1 negative virologic test result obtained at ≥8 weeks of age; or 1 negative HIV-1 antibody test result obtained at ≥6 months of age. Alternatively, presumptive exclusion of HIV-1 infection can be based on 1 positive HIV-1 virologic test with at least 2 subsequent negative virologic test results (at least 1 of which is performed at ≥8 weeks of age) or negative HIV-1 antibody test results (at least 1 of which is performed at ≥6 months of age). Definitive exclusion of HIV-1 infection is based on 2 negative virologic test results, 1 obtained at ≥1 month of age and 1 obtained at ≥4 months of age, or 2 negative HIV-1 antibody test results from separate specimens obtained at ≥6 months of age. For both presumptive and definitive exclusion of infection, the child should have no other laboratory (eg, no positive virologic test results) or clinical (eg, no AIDS-defining conditions) evidence of HIV-1 infection. Many clinicians confirm the absence of HIV-1 infection with a negative HIV-1 antibody assay result at 12 to 18 months of age. For breastfeeding infants, a similar testing algorithm can be followed, with timing of testing starting from the date of complete cessation of breastfeeding instead of the date of birth.

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Section: Hiv-1 Culturementioning

confidence: 99%

Section: P24 Antigen Assaysmentioning

confidence: 99%

Diagnosis of HIV-1 Infection in Children Younger Than 18 Months in the United States

Read¹

2007

Pediatrics

118

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“…By using methods to evidence HIV-1 directly, either by cell culture for virus isolation or polymerase chain reaction (PCR) for HIV-1 DNA sequence detection, we and others (2)(3)(4)(5)(6) demonstrated that a consistent proportion of infants who were subsequently recognized as HIV-1 infected do not have detectable levels of virus in their peripheral blood cells at birth. Conversely, Ͼ 95% of these infected infants have detectable virus levels when tested at 4-8 weeks of age.…”

Section: Introductionmentioning

confidence: 97%

Dynamics of viral replication in infants with vertically acquired human immunodeficiency virus type 1 infection.

Rossi¹,

Masiero²,

Giaquinto³

et al. 1996

J. Clin. Invest.

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About one-third of vertically HIV-1 infected infants develop AIDS within the first months of life; the remainder show slower disease progression. We investigated the relationship between the pattern of HIV-1 replication early in life and disease outcome in eleven infected infants sequentially studied from birth. Viral load in cells and plasma was measured by highly sensitive competitive PCR-based methods.Although all infants showed an increase in the indices of viral replication within their first weeks of life, three distinct patterns emerged: ( a ) a rapid increase in plasma viral RNA and cell-associated proviral DNA during the first 4-6 wk, reaching high steady state levels ( Ͼ 1,000 HIV-1 copies/10 5 PBMC and Ͼ 1,000,000 RNA copies/ml plasma) within 2-3 mo of age; ( b ) a similar initial rapid increase in viral load, followed by a 2.5-50-fold decline in viral levels; ( c ) a significantly lower ( Ͼ 10-fold) viral increase during the first 4-6 wk of age. All infants displaying the first pattern developed early AIDS, while infants with slower clinical progression exhibited the second or third pattern.These findings demonstrate that the pattern of viral replication and clearance in the first 2-3 mo of life is strictly correlated with, and predictive of disease evolution in vertically infected infants. ( J. Clin. Invest. 1996. 97:323-330.)

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“…Severe symptoms (including encephalopathy) occur more frequently in infants with a heavy virus load in the blood (positive viral cultures during the first 2 months of life or positive p24 antigen at birth [8,10,12]) which is tightly linked to maternal status at delivery: a higher titer of circulating virus in the mother increases the rate of viral transmission to the baby, the amount of circulating virus in the baby and the probability of developing severe neurological symptoms [13]. Moreover, a higher liter of circulating virus in the mother probably also increases the risk of transmission during the last weeks of pregnancy instead of during delivery.…”

Section: Clinical Variations In the Intensity Of Neurological Symptommentioning

confidence: 99%

“…8,9], Moreover, in some cases, cultures which were initially negative become positive during the first 3 months of life and the concentration of p24 antigen increases during the same period. In the same way.…”

Section: Introductionmentioning

confidence: 99%

HIV-1 and the Developing Human Nervous System: In vivo and in vitro Aspects

Tardieu

Janabi²

1994

Dev Neurosci

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HIV-1 is able to penetrate the developing human central nervous system and induce damage. Clinical and neuropathological observations demonstrate that (a) the virus is transmitted during the late phase of pregnancy or at the time of delivery; (b) the main infected cells within the brain are macrophages, and (c) the mere presence of infected macrophages within CNS tissue is not enough to predict disease. Primary cultures of human embryonic or fetal CNS and derived cultures highly enriched in either astrocytes or microglial cells are useful tools to study the mechanisms of HIV-1-induced neuronotoxicity in which both microglial cells and astrocytes play important roles.

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The use of viral culture and p24 antigen testing to diagnose human immunodeficiency virus infection in neonates

Cited by 10 publications

References 0 publications

Diagnosis of HIV-1 Infection in Children Younger Than 18 Months in the United States

Diagnosis of HIV-1 Infection in Children Younger Than 18 Months in the United States

Dynamics of viral replication in infants with vertically acquired human immunodeficiency virus type 1 infection.

HIV-1 and the Developing Human Nervous System: In vivo and in vitro Aspects

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