Primary HIV-1 infection among infants in Sub-Saharan Africa: HPTN 024

Jennifer S. Read, Anthony Mwatha, Barbra Richardson, Megan Valentine, Lynda Emel, Karim Manji, Irving Hoffman, Usha Sharma, Robert L. Goldenberg, Taha E. Taha

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)317-322
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Volume51
Issue number3
DOIs
StatePublished - Jul 2009

Keywords

  • HIV-1
  • Infant
  • Primary infection

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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