Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
J Clin Virol. 2012 Nov;55(3):244-9. doi: 10.1016/j.jcv.2012.08.001. Epub 2012 Aug 24.
Excluding HIV infection among infants and young children in resource-poor settings where nucleic acid amplification tests (NAAT) are not routinely available remains a considerable challenge.
To assess the performance of two rapid HIV antibody tests (RT) used alone and in parallel for excluding HIV infection among acutely ill infants and children <18 months in comparison to NAAT in a region where maternal HIV prevalence was approximately 7%.
Infants and children ≥2<18 months admitted to hospital with an acute febrile illness had two rapid antibody tests in parallel, with single and parallel results subsequently compared against NAAT.
HIV prevalence among 1602 enrolled infants was 3.4%. All 1526 infants with 2 negative RT were HIV negative by NAAT. All 46 infants with 2 positive RT were HIV positive by NAAT. The overall specificity of two rapid tests for excluding HIV infection was 99.5%. Sensitivity and specificity were ≥99% and >98%, respectively, across all age brackets ≥2<18 months. Overall sensitivity and specificity for a single RT was 98.2% and 99%, respectively, for Determine, and 85.5% and 99.6%, respectively, for Capillus.
In a setting with a maternal HIV prevalence rate of <10%, a single negative RT had excellent specificity and two negative RT performed in parallel had a perfect negative predictive value for HIV infection among acutely ill patients <18 months of age. In this and similar settings, RT could assist with excluding HIV infection with much lower complexity and cost than NAAT.
在资源匮乏的环境中，由于无法常规进行核酸扩增检测（NAAT），因此排除婴儿和幼儿中的 HIV 感染仍然是一个巨大的挑战。
评估两种快速 HIV 抗体检测（RT）在母婴 HIV 流行率约为 7%的地区，单独使用和同时使用时在排除急性疾病的婴儿和儿童（<18 个月）中的 HIV 感染的性能，与 NAAT 进行比较。
患有急性发热疾病且年龄≥2<18 个月的住院婴儿和儿童同时进行两种快速抗体检测，随后将单独和同时的检测结果与 NAAT 进行比较。
纳入的 1602 名婴儿中 HIV 流行率为 3.4%。所有 1526 名 RT 检测均为阴性的婴儿通过 NAAT 检测均为 HIV 阴性。所有 46 名 RT 检测均为阳性的婴儿通过 NAAT 检测均为 HIV 阳性。两种快速检测排除 HIV 感染的总体特异性为 99.5%。在所有年龄组（≥2<18 个月）中，敏感性和特异性均≥99%和>98%。单个 RT 的总体敏感性和特异性分别为 98.2%和 99%，适用于 Determine，分别为 85.5%和 99.6%，适用于 Capillus。
在母婴 HIV 流行率<10%的环境中，单个阴性 RT 具有极好的特异性，同时进行两个阴性 RT 具有完美的阴性预测值，可以排除急性疾病的<18 个月婴儿的 HIV 感染。在这种和类似的环境中，RT 可以协助排除 HIV 感染，其复杂性和成本远低于 NAAT。
