Haeri Mazanderani Ahmad, Sherman Gayle G
Centre for HIV & STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
F1000Res. 2019 Sep 13;8. doi: 10.12688/f1000research.19637.1. eCollection 2019.
Early diagnosis of HIV infection among infants and children is critical as prompt initiation of antiretroviral therapy prevents morbidity and death. Yet despite advances in the accuracy and availability of infant HIV diagnostic testing, there are increasing challenges with making an early definitive diagnosis. These challenges relate primarily to advances in prevention of mother-to-child transmission (PMTCT) of HIV. Although PMTCT programs have proven to be highly effective in reducing infant HIV infection, infants who are HIV-infected may achieve virological suppression and loss of detectability of HIV nucleic acid prior to diagnosis because of antiretroviral drug exposure. Hence, false-negative and indeterminate HIV polymerase chain reaction (PCR) results can occur, especially among high-risk infants given multi-drug prophylactic regimens. However, the infant HIV diagnostic landscape is also complicated by the inevitable decline in the positive predictive value of early infant diagnosis (EID) assays. As PMTCT programs successfully reduce the mother-to-child transmission rate, the proportion of false-positive EID results will increase. Consequently, false-negative and false-positive HIV PCR results are increasingly likely despite highly accurate diagnostic assays. The problem is compounded by the seemingly intractable prevalence of maternal HIV within some settings, resulting in a considerable absolute burden of HIV-infected infants despite a low mother-to-child transmission rate.
婴幼儿HIV感染的早期诊断至关重要，因为尽早开始抗逆转录病毒治疗可预防发病和死亡。然而，尽管婴幼儿HIV诊断检测的准确性和可及性有所提高，但做出早期明确诊断面临的挑战却日益增加。这些挑战主要与预防HIV母婴传播（PMTCT）的进展有关。尽管PMTCT项目已被证明在降低婴幼儿HIV感染方面非常有效，但由于接触抗逆转录病毒药物，感染HIV的婴幼儿在诊断前可能实现病毒学抑制并失去HIV核酸的可检测性。因此，可能会出现HIV聚合酶链反应（PCR）假阴性和不确定结果，尤其是在接受多药预防方案的高危婴幼儿中。然而，早期婴幼儿诊断（EID）检测阳性预测值的必然下降也使婴幼儿HIV诊断情况变得复杂。随着PMTCT项目成功降低母婴传播率，EID假阳性结果的比例将会增加。因此，尽管诊断检测高度准确，但HIV PCR假阴性和假阳性结果越来越有可能出现。某些地区孕产妇HIV感染率居高不下，这一问题变得更加复杂，尽管母婴传播率较低，但HIV感染婴幼儿的绝对负担仍然相当大。
