Incorrectly diagnosing children as HIV-infected : experiences from a large paediatric antiretroviral therapy site in South Africa

Feucht, Ute Dagmar ; Thomas, Ute Dagmar ; Forsyth, Brian William Cameron ; Kruger, Mariana (2012-08)

The original publication is available at http://www.sajch.org.za/index.php/SAJCH

Article

Objective. To assess the extent to which children may be falsely diagnosed as HIV-infected, using data from an antiretroviral therapy (ART) site in Pretoria, South Africa. Methods. This was a retrospective patient record review of all ART-naïve children referred to Kalafong hospital’s paediatric HIV clinic between April 2004 and March 2010, with detailed review of those found to be HIV-uninfected. Results. There were 1 526 patient files analysed, with a male-to-female ratio of 1.01:1 and median age at first visit of 20 months (range 26 days - 17.5 years). Nearly half (n=715; 47%) of the children were aged <18 months. Fifty-one children were found to be HIV-uninfected after repeated diagnostic tests. Incorrect laboratory results for children aged <18 months included false-positive HIV DNA PCR tests (40), detectable HIV viral loads (4) and a false-positive HIV p24Ag test (1). One child above 18 months had false-positive HIV ELISA results. An additional 4 children were inappropriately referred after being incorrectly labelled as HIV-infected and 1 child aged <18 months was referred after an inappropriate diagnostic test for age was used. In summary, 1 in every 30 (3.3%) children was discharged HIV-uninfected, and below age 18 months, 1 in 16 children (6.3%) had false-positive HIV virological tests. Conclusions. Urgency in ART initiation in HIV-infected children is life-saving, especially in infants. However, HIV tests may produce false-positive results leading to misdiagnosis of children as HIV-infected, which has serious consequences. Meticulous checking of HIVpositive status is of utmost importance before committing any child to lifelong ART.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/82043
This item appears in the following collections: