Rapid Serological Tests Ineffectively Screen for HIV Exposure in HIV-Positive Infants

Urick, Brittany; Fong, Youyi; Okiira, Christopher; Nabukeera-Barungi, Nicolette; Nansera, Denis; Ochola, Emmanuel; Nteziyaremye, Julius; Bigira, Victor; Ssewanyana, Isaac; Peter, Trevor; Ghadrshenas, Anisa; Vojnov, Lara; Kiyaga, Charles

doi:10.1097/qai.0000000000001609

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…The absence of HIV molecular diagnosis in the clinical routine in EG does not allow the early diagnosis of HIV-exposed children born to HIV-infected women, which is essential to prevent the rapid progression of the disease in a country with a high (25%) mother-to-child HIV transmission rate [ 51 ]. The only diagnostic option available for children < 18 months is repeated rapid serological testing, which increases the risk of false HIV diagnoses and infant mortality if not treated in time [ 52 ]. The 2 (8%, 2/25) HIV-exposed children who were infected died before they could receive a confirmatory diagnosis and adequate ART.…”

Section: Discussionmentioning

confidence: 99%

High Drug Resistance Levels Compromise the Control of HIV Infection in Pediatric and Adult Populations in Bata, Equatorial Guinea

Rodriguez-Galet

Ventosa-Cubillo

Bendomo³

et al. 2022

Viruses

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A lack of HIV viral load (VL) and HIV drug resistance (HIVDR) monitoring in sub-Saharan Africa has led to an uncontrolled circulation of HIV-strains with drug resistance mutations (DRM), compromising antiretroviral therapy (ART). This study updates HIVDR data and HIV-1 variants in Equatorial Guinea (EG), providing the first data on children/adolescents in the country. From 2019–2020, 269 dried blood samples (DBS) were collected in Bata Regional Hospital (EG) from 187 adults (73 ART-naïve/114 ART-treated) and 82 children/adolescents (25 HIV-exposed-ART-naïve/57 ART-treated). HIV-1 infection was confirmed in Madrid by molecular/serological confirmatory tests and ART-failure by VL quantification. HIV-1 pol region was identified as transmitted/acquired DRM, predicted antiretroviral susceptibility (Stanfordv9.0) and HIV-1 variants (phylogeny). HIV infection was confirmed in 88.1% of the individuals and virological failure (VL > 1000 HIV-1-RNA copies/mL) in 84.2/88.9/61.9% of 169 ART-treated children/adolescents/adults. Among the 167 subjects with available data, 24.6% suffered a diagnostic delay. All 125 treated had experienced nucleoside retrotranscriptase inhibitors (NRTI); 95.2% were non-NRTI (NNRTI); 22.4% had experienced integrase inhibitors (INSTI); and 16% had experienced protease inhibitors (PI). At sampling, they had received 1 (37.6%), 2 (32%), 3 (24.8%) or 4 (5.6%) different ART-regimens. Among the 43 treated children–adolescents/37 adults with sequence, 62.8/64.9% carried viruses with major-DRM. Most harbored DRM to NNRTI (68.4/66.7%), NRTI (55.3/43.3%) or NRTI+NNRTI (50/33.3%). One adult and one child carried major-DRM to PI and none carried major-DRM to INSTI. Most participants were susceptible to INI and PI. DRM was absent in 36.2% of treated patients with VL > 1000 cp/mL, suggesting adherence failure. TDR prevalence in 59 ART-naïve adults was high (20.3%). One-half (53.9%) of the 141 subjects with pol sequence carried CRF02_AG. The observed high rate of ART-failure and transmitted/acquired HIVDR could compromise the 95-95-95-UNAIDS targets in EG. Routine VL and resistance monitoring implementation are mandatory for early detection of ART-failure and optimal rescue therapy selection ART regimens based on PI, and INSTI can improve HIV control in EG.

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Section: Discussionmentioning

confidence: 99%

High Drug Resistance Levels Compromise the Control of HIV Infection in Pediatric and Adult Populations in Bata, Equatorial Guinea

Rodriguez-Galet

Ventosa-Cubillo

Bendomo³

et al. 2022

Viruses

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“…This circumstance is of particular concern at HCM, which is in a higher-HIV prevalence province and has approximately 60% more admissions per month, but had fewer inpatient POC tests performed per month than did HCB (16.5 versus 18.3). 19 11,[20][21][22] Concerningly, a study of pediatric inpatient PITC from wards in Mozambique reported that coverage rates are low. 13 Routine opt-out rapid antibody testing of breastfeeding mothers is a crucial first step to newly identify HEIs who need EID testing, and this step can help improve POC EID platform utilization.…”

Section: Discussionmentioning

confidence: 99%

Inpatient Point-of-Care HIV Early Infant Diagnosis in Mozambique to Improve Case Identification and Linkage to Antiretroviral Therapy

Matsinhe

Bollinger

Lee³

et al. 2021

Glob Health Sci Pract

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“…In addition, due to changing transmission dynamics and recent evidence that rapid serologic testing has a high rate of false negatives, the WHO now recommends that the 9-month rapid serologic test may be replaced with a virologic test. [4][5][6] There are a number of times when loss to follow-up (LTFU) occurs throughout the EID cascade, from the time the patient presents for sample collection to the caregiver's receipt of results and the clinical decision-making. Emerging evidence has shown that POC EID significantly reduces turnaround time (TAT), increases the percentage of results returned to caregivers, and increases the percentage of HIV-infected infants initiated on ART.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Point-of-Care Early Infant Diagnosis Improves Adherence to the Testing Algorithm in Kenya

Odhiambo

Githuka

Bowen³

et al. 2020

J Int Assoc Provid AIDS Care

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Introduction: We determine the level of adherence to the revised Kenya early infant diagnosis (EID) algorithm during implementation of a point-of-care (POC) EID project. Methods: Data before (August 2016 to July 2017) and after (August 2017 to July 2018) introduction of POC EID were collected retrospectively from the national EID database and registers for 33 health facilities. We assessed the number of HIV-infected infants who underwent confirmatory testing and received baseline viral load test and proportion of infants with an initial negative result who had a subsequent test. Results and Discussion: Significantly higher number of infants accessed confirmatory testing (94.2% versus 38.6%; P < .0001) with POC EID. Baseline viral load test and follow-up testing at 6 months, although higher with POC EID, were not significantly different from the pre-POC EID intervention period. Conclusion: The POC EID implementation has the potential to increase proportion of infants who receive confirmatory testing, thus reducing the risk of false-positive results.

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Rapid Serological Tests Ineffectively Screen for HIV Exposure in HIV-Positive Infants

Cited by 5 publications

References 14 publications

High Drug Resistance Levels Compromise the Control of HIV Infection in Pediatric and Adult Populations in Bata, Equatorial Guinea

High Drug Resistance Levels Compromise the Control of HIV Infection in Pediatric and Adult Populations in Bata, Equatorial Guinea

Inpatient Point-of-Care HIV Early Infant Diagnosis in Mozambique to Improve Case Identification and Linkage to Antiretroviral Therapy

Point-of-Care Early Infant Diagnosis Improves Adherence to the Testing Algorithm in Kenya

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