False-positive HIV DNA PCR testing of infants : implications in a changing epidemic

dc.contributor.authorFeucht, Ute
dc.contributor.authorForsyth, Brian
dc.contributor.authorKruger, Mariana
dc.identifier.citationFeucht, U., Forsyth, B. & Kruger, M. 2012. False-positive HIV DNA PCR testing of infants : implications in a changing epidemic. South African Medical Journal, 102(3):149-152.en_ZA
dc.identifier.issn2078-5135 (online)
dc.identifier.issn0256-9574 (print)
dc.descriptionThe original publication is available at
dc.description.abstractAim. To examine false-positive HIV DNA polymerase chain reaction (PCR) test results in children, and the potential implications for the paediatric HIV epidemic in sub-Saharan Africa. Methods. A review was done of records over a 6-year period of children less than 18 months old at an HIV treatment site in South Africa, to evaluate those with an initial 'false'-positive HIV DNA PCR result, but later proven to be HIV-uninfected with HIV DNA PCR and/or quantitative HIV RNA PCR tests. We calculated the influence of changing HIV transmission rates on predictive values (PV) of HIV DNA PCR tests in a hypothetical population of all HIV-exposed infants over a 1-year period. (Positive PV: proportion of individuals with a positive test with disease; negative PV: proportion of individuals with negative test and no disease). Results. Of 718 children, 40 with an initial positive HIV DNA PCR test were subsequently proven to be HIV-uninfected, resulting in a positive PV of 94.4%. Most (75%) uninfected children had PMTCT interventions and were asymptomatic or mildly symptomatic (77.5%). Calculations using a test specificity of 99.4%, as reported previously, show a decrease in positive PV using a single-test strategy from 98.6% at 30% HIV transmission rate, to 94.8% at 10% transmission, to 62.5% at 1% transmission. Reduction in test specificity further decreases positive PV at low transmission rates. Conclusion. Decreasing mother-to-child HIV transmission rates reduce the positive predictive value of a single HIV DNA PCR test result, necessitating adaptations to diagnostic algorithms to avoid misdiagnosis and inappropriate treatment, especially with early initiation of antiretroviral therapy in asymptomatic infants.
dc.format.extentpp. 149-152 : col. ill.
dc.publisherHealth and Medical Publishing Group (HMPG)en_ZA
dc.subjectHIV infections -- Prevention -- Sub-Saharan Africaen_ZA
dc.subjectHIV positive children -- Treatment -- Sub-Saharan Africaen_ZA
dc.subjectDiagnostic error -- Complicationsen_ZA
dc.subjectHIV infections in children -- Diagnosis -- Complicationsen_ZA
dc.subject.lcshDiagnostic erroren_ ZA
dc.subject.lcshHIV infections -- Transmission -- Sub-Saharan Africaen_ZA
dc.titleFalse-positive HIV DNA PCR testing of infants : implications in a changing epidemicen_ZA
dc.description.versionPublishers’ version
dc.rights.holderAuthors retain copyrighten_ZA

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