Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
Sensitivity and specificity of a qualitative RNA detection assay to diagnose HIV infection in young infants. Perinatal AIDS Collaborative Transmission Study.
AIDS. 1998 Aug 20;12(12):1545-9. Unique Identifier : AIDSLINE MED/98394560 Simonds RJ; Brown TM; Thea DM; Orloff SL; Steketee RW; Lee FK; Palumbo PE; Kalish ML; Division of HIV/AIDS Prevention, Centers for Disease Control and; Prevention, Atlanta, Georgia, USA.
Abstract:
OBJECTIVE: To evaluate the sensitivity and specificity of an RNA detection assay for diagnosing perinatal HIV infection. METHODS: Plasma and serum specimens taken during the first 3 months of life from HIV-infected and uninfected children enrolled in a cohort study were assayed for HIV RNA using the qualitative nucleic acid sequence-based amplification (NASBA) kit. Sensitivity, specificity, and predictive values were calculated. NASBA results from infected children were compared with DNA PCR results from the same blood samples. Autoantibody patterns of suspected false-positive specimens were compared with those of subsequent specimens from the same child to exclude specimen labelling errors. RESULTS: Amongst 131 specimens from 105 HIV-infected children, the sensitivity of the qualitative NASBA assay was 13 out of 34 [38%; 95% confidence interval (CI), 22-56] at < 7 days, 56 out of 58 (97%; 95% CI, 88-100) at 7-41 days, and 37 out of 39 (95%; 95% CI, 83-99) at 42-93 days of life. Of 252 specimens from 206 uninfected children, six tested positive and one tested indeterminate by NASBA. Four of these positive specimens had discordant autoantibody patterns suggesting mislabelling; excluding these, the test specificity was 245 out of 248 (99%; 95% CI, 97-100). Amongst 128 paired specimens from infected children, NASBA results were more often positive than those from DNA PCR (103 versus 92; P=0.01). Amongst infants with specimens drawn in the first week of life, the proportion born after > 4 h of membrane rupture was greater amongst those testing negative (81%) than those testing positive (46%; P=0.05). CONCLUSIONS: The qualitative NASBA RNA assay is highly specific and more sensitive than DNA PCR. Qualitative RNA assays may be useful for diagnosing and excluding perinatal HIV infection in children after the first week of life for such purposes as initiating antiretroviral therapy and other treatment, resolving parental uncertainty, determining timing of transmission, and providing endpoints for intervention trials.
Keywords: JOURNAL ARTICLE Cohort Studies Disease Transmission, Vertical Evaluation Studies Human HIV Infections/*DIAGNOSIS/TRANSMISSION HIV-1/*GENETICS Infant Infant, Newborn Polymerase Chain Reaction/*METHODS Predictive Value of Tests Reagent Kits, Diagnostic RNA, Viral/*BLOOD Sensitivity and Specificity 990130
A9911025
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Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
