TY - JOUR
T1 - Primary HIV-1 infection among infants in Sub-Saharan Africa
T2 - HPTN 024
AU - Read, Jennifer S.
AU - Mwatha, Anthony
AU - Richardson, Barbra
AU - Valentine, Megan
AU - Emel, Lynda
AU - Manji, Karim
AU - Hoffman, Irving
AU - Sharma, Usha
AU - Goldenberg, Robert L.
AU - Taha, Taha E.
PY - 2009/7
Y1 - 2009/7
N2 - OBJECTIVES: Our objectives were to assess clinical signs and diagnoses associated with primary HIV-1 infection among infants. METHODS: We analyzed data from a clinical trial (HIV Prevention Trials Network Protocol 024) in sub-Saharan Africa. Study visits were conducted at birth*at 4-6 weeks, and at 3, 6, 9, and 12 months. The study population comprised live born, singleton, first-born infants of HIV-1-infected women with negative HIV-1 RNA assays who were still breastfeeding at 4-6 weeks. RESULTS: Of 1317 HIV-1-exposed infants, 84 became HIV-1 infected after 4-6 weeks and 1233 remained uninfected. There were 102 primary and 5650 nonprimary infection visits. The most common signs were cough and diarrhea, and the most common diagnoses were malaria and pneumonia. Primary infection was associated with significantly increased odds of diarrhea [odds ratio (OR) = 2.4], pneumonia (OR = 3.5), otitis media (OR = 3.1), and oral thrush (OR = 2.9). For the clinical signs and diagnoses evaluated, sensitivity was low (1%-16.7%) and specificity was high (88.2%-99%). Positive predictive values ranged from 0.1%-1.4%. Negative predictive values ranged from 28.0%-51.1%. CONCLUSIONS: Certain clinical signs and diagnoses, although more common during primary HIV-1 infection, had low sensitivity and high specificity. Efforts to expand access to laboratory assays for the diagnosis of primary HIV-1 infection among infants of HIV-1-infected women should be emphasized.
AB - OBJECTIVES: Our objectives were to assess clinical signs and diagnoses associated with primary HIV-1 infection among infants. METHODS: We analyzed data from a clinical trial (HIV Prevention Trials Network Protocol 024) in sub-Saharan Africa. Study visits were conducted at birth*at 4-6 weeks, and at 3, 6, 9, and 12 months. The study population comprised live born, singleton, first-born infants of HIV-1-infected women with negative HIV-1 RNA assays who were still breastfeeding at 4-6 weeks. RESULTS: Of 1317 HIV-1-exposed infants, 84 became HIV-1 infected after 4-6 weeks and 1233 remained uninfected. There were 102 primary and 5650 nonprimary infection visits. The most common signs were cough and diarrhea, and the most common diagnoses were malaria and pneumonia. Primary infection was associated with significantly increased odds of diarrhea [odds ratio (OR) = 2.4], pneumonia (OR = 3.5), otitis media (OR = 3.1), and oral thrush (OR = 2.9). For the clinical signs and diagnoses evaluated, sensitivity was low (1%-16.7%) and specificity was high (88.2%-99%). Positive predictive values ranged from 0.1%-1.4%. Negative predictive values ranged from 28.0%-51.1%. CONCLUSIONS: Certain clinical signs and diagnoses, although more common during primary HIV-1 infection, had low sensitivity and high specificity. Efforts to expand access to laboratory assays for the diagnosis of primary HIV-1 infection among infants of HIV-1-infected women should be emphasized.
KW - HIV-1
KW - Infant
KW - Primary infection
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U2 - 10.1097/QAI.0b013e31819c18c3
DO - 10.1097/QAI.0b013e31819c18c3
M3 - Article
C2 - 19367174
AN - SCOPUS:67651068747
SN - 1525-4135
VL - 51
SP - 317
EP - 322
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 3
ER -