False-negative post-18-month confirmatory HIV tests in HIV DNA PCR-positive children

Garcia-Prats, Anthony J; Draper, Heather R.; Sanders, Jill; Agrawal, Anurag K.; Mohapi, Edith Q.; Schutze, Gordon E.

doi:10.1097/qad.0b013e32835705bf

Cited by 16 publications

(11 citation statements)

References 24 publications

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“…There are concerning anecdotal reports of health care workers stopping ART in children testing antibody negative based on mistaken assumptions. 12 Thus, better understanding of the frequency of this phenomenon in clinical populations, particularly in sub-Saharan Africa, is important to ensure appropriate clinical management for HIV-infected children. Existing published reports provide limited information about the frequency of HIV antibody negativity in ART-treated children and are largely based on small numbers of highly-select children from academic centers in North America and Europe.…”

Section: Introductionmentioning

confidence: 99%

Young age at start of antiretroviral therapy and negative HIV antibody results in HIV-infected children when suppressed

Kuhn

Schramm²,

Shiau

et al. 2015

Aids

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Background Negative results on standard HIV antibody tests have been described among HIV-infected children suppressed on antiretroviral therapy (ART) started early in life. Here we describe the frequency and predictors of this phenomenon in a well-characterized cohort of treated children. Methods We selected samples from 103 HIV-infected children who started ART ≤ 14 months of age and from 122 children who started ≤ 6 months of age followed as part of two sequential clinical trials in Johannesburg, South Africa. Children had attained viral suppression on ART and had received ART for between 3 and 6.4 years (mean 4.3 years) when tested for HIV antibody using a standard ELISA (Genescreen™ HIV1/2 version 2; Bio-rad). Results Only children ≤6 months of age when ART was started had negative antibody results when tested after suppression on ART several years later. Negative or low-positive antibody results were observed in 40.0%, 37.0% and 27.8% of children starting ART <2 months of age, or starting during month 2 or 3, respectively. This dropped to 5.9%, 3.5%, and 5.3% if ART was started during month 4, 5, and 6, respectively. Higher CD4 percentage prior to ART initiation and no recorded intermittent viremia also predicted negative antibody results. Conclusion Testing negative on standard HIV antibody tests occurs fairly commonly among HIV-infected children who started ART ≤ 3 months of age and are virally-suppressed. It would be prudent in clinical practice to avoid HIV antibody tests among virally-suppressed, early-treated children to prevent unnecessary confusion.

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Section: Introductionmentioning

confidence: 99%

Young age at start of antiretroviral therapy and negative HIV antibody results in HIV-infected children when suppressed

Kuhn

Schramm²,

Shiau

et al. 2015

Aids

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“…In addition, false-negative HIV tests have been reported in infants started on ART therapy soon after birth who were HIV DNA PCR-positive [12,13]. This may be explained by the decreased antigen presentation due to longstanding suppressed viral replication.…”

Section: Resultsmentioning

confidence: 99%

“…In a study in Tanzania, 44% of participants to a study believed that certain alternative treatments can cure HIV [20], and in another study seeking cure at a faith healer was associated with a significant decrease in treatment adherence [21]. In the absence of adequate counselling and patient education, a false-negative test result may lead to a wrong perception of cure, leading to ART interruption and exit from HIV care [12]. Additionally, with the scale up of PrEP, there is a possible risk of delayed HIV diagnosis given the longer time required for OFT to become positive in individuals taking PrEP.…”

Section: Resultsmentioning

confidence: 99%

False‐negative HIV tests using oral fluid tests in children taking antiretroviral therapy from Harare, Zimbabwe

Olaru

McHugh

Dakshina

et al. 2017

Journal of the International AIDS Society

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Introduction: Rapid diagnostic tests (RDT) for HIV infection have high sensitivity and specificity, but in the setting of longstanding antiretroviral therapy (ART), can give false results that can lead to misinterpretation, confusion and inadequate management. The objective of this study was to evaluate the proportion of falsely negative results of a RDT performed on oral fluid in HIV-infected children on longstanding ART. Methods: One hundred and twenty-nine children with known HIV infection and receiving ART were recruited from the HIV Clinic at the Harare Central Hospital, Zimbabwe. HIV testing was performed on oral fluid and on finger-stick blood. Results and Discussion: Children included in the study had a median age of 12 years (IQR 10–14) and 67 (51.9%) were female. Median age at HIV diagnosis was 5 years (IQR 3–6) and the median time on ART was 6.3 years (IQR 4.3–8.1). The oral fluid test was negative in 11 (8.5%) patients and indeterminate in 2 (1.6%). Finger-stick blood test was negative in 1 patient. Patients with a negative oral fluid test had a higher CD4 cell count (967 vs. 723 cells/mm3, p = 0.016) and a longer time on ART (8.5 vs. 6 years, p = 0.016). Conclusions: This study found that a substantial proportion of false-negative HIV test results in children on longstanding ART when using an oral fluid test. This could lead to misinterpretation of HIV test results and in the false perception of cure or delayed diagnosis.

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“…Serologic tests among children younger than 18 months will not be informative as a positive test may indicate the presence of maternal antibodies in an uninfected child and a negative test may result from successful control of viral replication in an infected child. 10 HIV RNA and DNA tests will be more useful for confirming HIV infection if positive but, similar to serologic tests, may not inform the absence of infection if negative. 10 If serologic and nucleic acid tests are negative, stopping treatment may be the only management option.…”

mentioning

confidence: 97%

“…10 HIV RNA and DNA tests will be more useful for confirming HIV infection if positive but, similar to serologic tests, may not inform the absence of infection if negative. 10 If serologic and nucleic acid tests are negative, stopping treatment may be the only management option. As an alternative, a second confirmatory sample could be collected at treatment initiation and stored for testing in the event of discrepant results.…”

mentioning

confidence: 97%

False-Positive HIV Test Results in Infancy and Management of Uninfected Children Receiving Antiretroviral Therapy

Sutcliffe

Moss

Thuma

2015

Pediatric Infectious Disease Journal

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False-negative post-18-month confirmatory HIV tests in HIV DNA PCR-positive children

Cited by 16 publications

References 24 publications

Young age at start of antiretroviral therapy and negative HIV antibody results in HIV-infected children when suppressed

Young age at start of antiretroviral therapy and negative HIV antibody results in HIV-infected children when suppressed

False‐negative HIV tests using oral fluid tests in children taking antiretroviral therapy from Harare, Zimbabwe

False-Positive HIV Test Results in Infancy and Management of Uninfected Children Receiving Antiretroviral Therapy

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