Loss of detectability and indeterminate results : challenges facing HIV infant diagnosis in South Africa's expanding ART programme

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dc.contributor.author Haeri Mazanderani, Ahmad F.
dc.contributor.author Du Plessis, Nicolette M.
dc.contributor.author Thomas, Winifred Nancy
dc.contributor.author Venter, E.
dc.contributor.author Avenant, T.J. (Theunis Johannes)
dc.date.accessioned 2014-08-14T06:13:30Z
dc.date.available 2014-08-14T06:13:30Z
dc.date.issued 2014-08
dc.description.abstract BACKGROUND. Early infant diagnosis with rapid access to treatment has been found to reduce HIV-associated infant mortality and morbidity considerably. In line with international standards, current South African guidelines advocate routine HIV-1 polymerase chain reaction (PCR) testing at 6 weeks of age for all HIV-exposed infants and ‘fast-track’ entry into the HIV treatment programme for those who test positive. Importantly, testing occurs within the context of increasing efforts at prevention of mother-to-child transmission (PMTCT) by means of maternal and infant antiretroviral therapy (ART). In addition, infants already initiated on combination ART (cART) may be retested with PCR assays for ‘confirmatory’ purposes, including assessment prior to adoption. The potential for cART to compromise the sensitivity of HIV-1 PCR assays has been described, although there are limited and conflicting data regarding the effect of PMTCT regimens on HIV-1 PCR diagnostic sensitivity. METHODS. We describe a case series of three infants with different ART exposures in whom HIV diagnosis, confirmation or the result of retesting for adoption purposes were uncertain. RESULTS. These cases demonstrate that ART can be associated with a loss of detectability of HIV, leading to ‘false-negative’ HIV-1 PCR results in infants on cART. Furthermore, current PMTCT practices may lead to repeatedly indeterminate results with a subsequent delay in initiation of cART. CONCLUSION. The sensitivity of HIV-1 PCR assays needs to be re-evaluated within the context of different ART exposures, and diagnostic algorithms should be reviewed accordingly. en_US
dc.description.librarian am2014 en_US
dc.description.uri http://www.samj.org.za en_US
dc.identifier.citation Haeri Mazanderani, AF, Du Plessis, NM, Thomas, WN, Venter, E & Avenant, T 2014, 'Loss of detectability and indeterminate results : challenges facing HIV infant diagnosis in South Africa's expanding ART programme', South African Medical Journal, vol. 104, no. 8, pp. 574-577. en_US
dc.identifier.issn 0256-9574 (print)
dc.identifier.issn 2078-5135 (online)
dc.identifier.other 10.7196/SAMJ.8322
dc.identifier.uri http://hdl.handle.net/2263/41263
dc.language.iso en en_US
dc.publisher Health and Medical Publishing Group en_US
dc.rights Health and Medical Publishing Group en_US
dc.subject Human immunodeficiency virus (HIV) en_US
dc.subject HIV infant diagnosis en_US
dc.subject Antiretroviral therapy (ART) en_US
dc.subject HIV-1 PCR testing en_US
dc.subject Polymerase chain reaction (PCR) en_US
dc.subject South Africa (SA) en_US
dc.title Loss of detectability and indeterminate results : challenges facing HIV infant diagnosis in South Africa's expanding ART programme en_US
dc.type Article en_US


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