婴幼儿快速血清学检测无法可靠地评估患病住院婴幼儿的HIV暴露情况。
Infant/child rapid serology tests fail to reliably assess HIV exposure among sick hospitalized infants.
作者信息
Wagner Anjuli D, Njuguna Irene N, Andere Ruth A, Cranmer Lisa M, Okinyi Helen M, Benki-Nugent Sarah, Chohan Bhavna H, Maleche-Obimbo Elizabeth, Wamalwa Dalton C, John-Stewart Grace C
机构信息
aDepartment of Global Health, University of Washington, Seattle, Washington, USA bKenyatta National Hospital, Nairobi, Kenya cDepartment of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA dDepartment of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya eDepartment of Medicine, University of Washington, Seattle, Washington, USA fKenya Medical Research Institute, Nairobi, Nairobi, Kenya gDepartment of Epidemiology hDepartment of Pediatrics, University of Washington, Seattle, Washington, USA. *Anjuli D. Wagner and Irene N. Njuguna are co-first authors.
出版信息
AIDS. 2017 Jul 17;31(11):F1-F7. doi: 10.1097/QAD.0000000000001562.
BACKGROUND
The WHO guidelines for infant and child HIV diagnosis recommend the use of maternal serology to determine child exposure status in ages 0-18 months, but suggest that infant serology can reliably be used to determine exposure for those less than 4 months. There is little evidence about the performance of these recommendations among hospitalized sick infants and children.
METHODS
Within a clinical trial (NCT02063880) in Kenya, among children 18 months or younger, maternal and child rapid serologic HIV tests were performed in tandem. Dried blood spots were tested using HIV DNA PCR for all children whose mothers were seropositive, irrespective of child serostatus. We characterized the performance of infant/child serology results to detect HIV exposure in three age groups: 0-3, 4-8, and 9-18 months.
RESULTS
Among 65 maternal serology positive infants age 0-3 months, 48 (74%), 1 (2%) and 16 (25%) had positive, indeterminate and negative infant serology results, respectively. Twelve (25%), 0 and 4 (25%) of those with positive, indeterminate and negative infant serology results, respectively, were HIV-infected by DNA PCR. Among 71 maternal serology positive infants age 4-8 months, 31 (44%), 8 (11%) and 32 (45%) had positive, indeterminate and negative infant serology results, respectively. Fourteen (45%), 2 (25%) and 7 (22%) infants with positive, indeterminate and negative infant serology results, respectively, were HIV-infected. Among 67 maternal serology positive infants/children age 9-18 months, 40 (60%), 2 (3%) and 25 (37%) had positive, indeterminate and negative infant serology results, respectively. Thirty-six (90%), 2 (100%) and 2 (8%) infants with positive, indeterminate and negative infant serology results, respectively, were HIV-infected. In the 0-3, 4-8 and 9-18 month age groups, use of maternal serology to define HIV exposure identified 33% [95% confidence interval (CI) 10-65%], 44% (95% CI 20-70%) and 5% (95% CI 0.1-18%) more HIV infections, respectively.
CONCLUSION
Maternal serology should preferentially be used for screening among hospitalized infants of all ages to improve early diagnosis of children with HIV.
背景
世界卫生组织（WHO）关于婴幼儿HIV诊断的指南建议使用母亲血清学检测来确定0 - 18个月儿童的HIV暴露状况，但指出对于小于4个月的婴儿，婴儿血清学检测可可靠地用于确定暴露情况。关于这些建议在住院患病婴幼儿中的执行情况，几乎没有相关证据。
方法
在肯尼亚的一项临床试验（NCT02063880）中，对18个月及以下的儿童同时进行了母亲和儿童的HIV快速血清学检测。对于母亲血清学呈阳性的所有儿童，无论其自身血清学状态如何，均使用HIV DNA PCR对干血斑进行检测。我们对三个年龄组（0 - 3个月、4 - 8个月和9 - 18个月）的婴幼儿血清学检测结果在检测HIV暴露方面的表现进行了描述。
结果
在65名0 - 3个月母亲血清学呈阳性的婴儿中，分别有48名（74%）、1名（2%）和16名（25%）婴儿血清学检测结果为阳性、不确定和阴性。婴儿血清学检测结果为阳性、不确定和阴性的儿童中，分别有12名（25%）、0名和4名（25%）通过DNA PCR检测确诊感染HIV。在71名4 - 8个月母亲血清学呈阳性的婴儿中，分别有31名（44%）、8名（11%）和32名（45%）婴儿血清学检测结果为阳性、不确定和阴性。婴儿血清学检测结果为阳性、不确定和阴性的婴儿中，分别有14名（45%）、2名（25%）和7名（22%）感染HIV。在67名9 - 18个月母亲血清学呈阳性的婴幼儿中，分别有40名（60%）、2名（3%）和25名（37%）婴幼儿血清学检测结果为阳性、不确定和阴性。婴幼儿血清学检测结果为阳性、不确定和阴性的儿童中，分别有36名（90%）、2名（100%）和2名（8%）感染HIV。在0 - 3个月、4 - 8个月和9 - 18个月年龄组中，使用母亲血清学检测来确定HIV暴露分别多发现了33% [95%置信区间（CI）10 - 65%]、44%（95% CI 20 - 70%）和5%（95% CI 0.1 - 18%）的HIV感染病例。
结论
对于所有年龄的住院婴儿，应优先使用母亲血清学检测进行筛查，以改善HIV感染儿童的早期诊断。
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