Use of polymerase chain reaction and quantitative antibody tests in children born to human immunodeficiency virus‐1‐infected mothers

Abstract

The diagnosis of human immunodeficiency virus (HIV) infection in children born to HIV-infected mothers is complicated by the presence of passively acquired maternal antibodies, and exclusion of infection in these infants remains problematic. The use of genome detection by polymerase chain reaction (PCR) amplification and the quantification of anti-HIV-1 antibodies were examined as methods for early diagnosis. Blood samples were taken from 84 non-breast-fed infants of HIV-infected mothers in five Italian and Spanish centres, a subgroup of children enrolled in the European Collaborative Study (ECS) for whom clinical and immunological information has been documented from birth. Whole blood was added to glycigel cryopreservative, stored, and tested in the United Kingdom by a nested PCR method. Antibody to HIV-1 was detected and quantified by titration using a gelatin particle agglutination test. PCR sensitivity and specificity were assessed. Twenty-one of the 84 children tested were infected. The estimated PCR sensitivity ranged from 0% (95% CI 0-26%) on day 1, 57% (19-85) on day 7, to 63% (33-92) on day 30. The negative predictive value of PCR ranged from 85% (83-88) on day 0 to 98% (94-100) at 3 months of age. On average, the level of maternal antibody halved every 33 days (31-36.5) in uninfected children. Between 6 and 9 months of age, increases in antibody titres in infected children were not more informative than absolute levels. These findings suggest that antibody measurement may supplement genomic diagnosis and that this collection method provides an alternative to the use of dried blood spots.

Reduced Mortality Associated With Breast-Feeding-Acquired HIV Infection and Breast-Feeding Among HIV-Infected Children in Zambia

“…To assess time of transmission, dried blood heel-stick samples were obtained for each child at each visit and extracted DNA was tested for HIV by polymerase chain reaction (PCR). [19][20][21] Clinic or home follow-up visits were scheduled for birth, 1 week, 1 month, monthly through 6 months, and then every 3 months through 2 years. Time of HIV infection was considered to be the midpoint between birth or the last negative test result and the first positive test result.…”

Detección de anticuerpos IgA y PCR como primeras opciones en el diagnóstico de infección perinatal por el VIH-1

“…Los datos de este estudio muestran que la PCR es muy sensible y muy específica en el diagnóstico de VIH-1 en niños menores de 24 meses de edad, sin embargo, es muy importante tener en cuenta que el no poder detectar el virus en las primeras semanas de vida no excluye la infección en el niño, ya que se ha demostrado que si la infección se adquirió en el momento del parto o después del parto el número de células infectadas puede ser muy reducido y estar por debajo de los límites de detección, tanto del cultivo viral como de la PCR. 11,12,[14][15][16][17][18] De igual modo se ha demostrado que un bebé no infectado puede haber adquirido de su madre fragmentos no replicativos de genoma viral que se detectan en la prueba de la PCR. 17 En nuestra experiencia también hemos encontrado niños con la PCR repetidamente positiva con varios pares de iniciadores que no han seroconvertido ni mostrado replicación viral a lo largo de varios años.…”

Diagnosis and monitoring of HIV infection

“…The South African Department of Health recommends testing the infant at 6 weeks and if negative, again at 4 months 10 . The second test at 4 months of age is necessary to detect infected infants who may have had undetectable levels of HIV-1 DNA at initial testing 11 . If there is ongoing exposure e.g.…”