Incorrectly diagnosing children as HIV-infected : experiences from a large paediatric antiretroviral therapy site in South Africa
Date
2012-08
Authors
Feucht, Ute Dagmar
Thomas, Ute Dagmar
Forsyth, Brian William Cameron
Kruger, Mariana
Journal Title
Journal ISSN
Volume Title
Publisher
Health and Medical Publishing Group (HMPG)
Abstract
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.
Description
The original publication is available at http://www.sajch.org.za/index.php/SAJCH
Keywords
Diagnostic errors -- Complications -- South Africa -- Gauteng, HIV positive children -- Diagnosis -- Complications -- South Africa -- Pretoria -- Case studies, HIV positive children -- Treatment -- South Africa -- Pretoria -- Case studies, Highly active antiretroviral therapy
Citation
Feucht, U. D., Thomas, W. N., Forsyth, B. W. C. & Kruger, M. 2012. Incorrectly diagnosing children as HIV-infected: Experiences from a large paediatric antiretroviral therapy site in South Africa. South African Journal of Child Health, 6(3):72-75, doi:10.7196/SAJCH.460.