The sensitivity of HIV-1 DNA polymerase chain reaction in the neonatal period and the relative contributions of intra-uterine and intra-partum transmission.

Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.

The sensitivity of HIV-1 DNA polymerase chain reaction in the neonatal period and the relative contributions of intra-uterine and intra-partum transmission.

AIDS. 1995 Sep;9(9):F7-11. Unique Identifier : AIDSLINE MED/96085711
Dunn DT; Brandt CD; Krivine A; Cassol SA; Roques P; Borkowsky W; De Rossi A; Denamur E; Ehrnst A; Loveday C; et al; Department of Epidemiology and Biostatics, Institute of Child; Health, London, UK.

Abstract: OBJECTIVE: To derive reliable estimates of the sensitivity of HIV-1 DNA polymerase chain reaction (PCR) in the neonatal period and to quantify the relative contributions of intra-uterine and intra-partum transmission. METHODS: After reviewing studies on the early diagnosis of HIV-1 infection, investigators were asked to provide published and unpublished PCR test results on prospectively followed, non-breastfed, vertically infected children. Age-specific estimates of the sensitivity of PCR were derived using distribution-free methods for interval-censored data. RESULTS: Data on 271 infected children were combined for analysis. PCR detected HIV-1 DNA in an estimated 38% [90% confidence interval (CI), 29-46] of HIV-infected children tested on the day of, or day after, birth. Sensitivity was observed to rise rapidly in the second week of life, reaching 93% (90% CI, 76-97) by 14 days of age. CONCLUSION: The sensitivity of PCR in the neonatal period is higher than previously reported. This affects the clinical interpretation of an early negative test result and encourages the use of PCR as an endpoint for trials to evaluate interventions to reduce vertical transmission in non-breastfed populations. Approximately one-third of vertically acquired HIV-1 infection could be attributable to intra-uterine transmission.

Keywords: *Disease Transmission, Vertical DNA, Viral/*GENETICS Female Human HIV Infections/DIAGNOSIS/*TRANSMISSION/VIROLOGY HIV-1/*GENETICS Infant, Newborn *Polymerase Chain Reaction Predictive Value of Tests Pregnancy Pregnancy Complications, Infectious/*DIAGNOSIS/VIROLOGY Prospective Studies Sensitivity and Specificity Support, Non-U.S. Gov't JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
960430
M9640875

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