Use of an Indeterminate Range in HIV Early Infant Diagnosis: A Systematic Review and Meta-Analysis

Robert Luo, Debi Boeras, Laura N. Broyles, Youyi Fong, Nei Yuan Hsiao, Charles Kiyaga, Ahmad Haeri Mazanderani, Landon Myer, Roger Shapiro, Gayle Sherman, Martina Penazzato, Meg Doherty, Lara Vojnov

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Expanded access to HIV antiretrovirals has dramatically reduced mother-to-child transmission of HIV. However, there is increasing concern around false-positive HIV test results in perinatally HIV-exposed infants but few insights into the use of indeterminate range to improve infant HIV diagnosis. METHODS: A systematic review and meta-analysis was conducted to evaluate the use of an indeterminate range for HIV early infant diagnosis. Published and unpublished studies from 2000 to 2018 were included. Study quality was evaluated using GRADE and QUADAS-2 criteria. A random-effects model compared various indeterminate ranges for identifying true and false positives. RESULTS: The review identified 32 studies with data from over 1.3 million infants across 14 countries published from 2000 to 2018. Indeterminate results accounted for 16.5% of initial non-negative test results, and 76% of indeterminate results were negative on repeat testing. Most results were from Roche tests. In the random-effects model, an indeterminate range using a polymerase chain reaction cycle threshold value of ≥33 captured over 93% of false positives while classifying fewer than 9% of true positives as indeterminate. CONCLUSIONS: Without the use of an indeterminate range, over 10% of infants could be incorrectly diagnosed as HIV positive if their initial test results are not confirmed. Use of an indeterminate range appears to lead to substantial improvements in the accuracy of early infant diagnosis testing and supports current recommendations to confirm all initial positive tests.

Original languageEnglish (US)
Pages (from-to)281-286
Number of pages6
JournalJournal of acquired immune deficiency syndromes (1999)
Volume82
Issue number3
DOIs
StatePublished - Nov 1 2019
Externally publishedYes

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Meta-Analysis
Early Diagnosis
HIV
Mothers
Polymerase Chain Reaction

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Use of an Indeterminate Range in HIV Early Infant Diagnosis : A Systematic Review and Meta-Analysis. / Luo, Robert; Boeras, Debi; Broyles, Laura N.; Fong, Youyi; Hsiao, Nei Yuan; Kiyaga, Charles; Mazanderani, Ahmad Haeri; Myer, Landon; Shapiro, Roger; Sherman, Gayle; Penazzato, Martina; Doherty, Meg; Vojnov, Lara.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 82, No. 3, 01.11.2019, p. 281-286.

Research output: Contribution to journalArticle

Luo, R, Boeras, D, Broyles, LN, Fong, Y, Hsiao, NY, Kiyaga, C, Mazanderani, AH, Myer, L, Shapiro, R, Sherman, G, Penazzato, M, Doherty, M & Vojnov, L 2019, 'Use of an Indeterminate Range in HIV Early Infant Diagnosis: A Systematic Review and Meta-Analysis', Journal of acquired immune deficiency syndromes (1999), vol. 82, no. 3, pp. 281-286. https://doi.org/10.1097/QAI.0000000000002104
Luo, Robert ; Boeras, Debi ; Broyles, Laura N. ; Fong, Youyi ; Hsiao, Nei Yuan ; Kiyaga, Charles ; Mazanderani, Ahmad Haeri ; Myer, Landon ; Shapiro, Roger ; Sherman, Gayle ; Penazzato, Martina ; Doherty, Meg ; Vojnov, Lara. / Use of an Indeterminate Range in HIV Early Infant Diagnosis : A Systematic Review and Meta-Analysis. In: Journal of acquired immune deficiency syndromes (1999). 2019 ; Vol. 82, No. 3. pp. 281-286.
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