Vertical transmission of HIV among pregnant women who initially had false–negative rapid HIV tests in four South African antenatal clinics


Autoři: Simnikiwe H. Mayaphi aff001;  Desmond J. Martin aff001;  Thomas C. Quinn aff004;  Anton C. Stoltz aff006
Působiště autorů: Department of Medical Virology, University of Pretoria, City of Tshwane, South Africa aff001;  National Health Laboratory Service–Tshwane Academic Division (NHLS–TAD), City of Tshwane, South Africa aff002;  Toga Laboratories, Johannesburg, South Africa aff003;  Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America aff004;  Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America aff005;  Division of Infectious Diseases, Department of Internal Medicine, University of Pretoria, City of Tshwane, South Africa aff006
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226391

Souhrn

Introduction

There is a risk of mother-to-child transmission of HIV (MTCT) during pregnancy and breastfeeding. The aim of this study was to assess vertical transmission of HIV among pregnant women who initially had false–negative rapid HIV tests in South African antenatal care (ANC) clinics.

Methods

Pregnant participants were enrolled in a diagnostic study that used nucleic acid amplification testing (NAAT) to screen for early HIV infection among individuals who tested negative on rapid HIV tests used at the point-of-care (POC) facilities. Participants were enrolled from four ANC clinics in the Tshwane district of South Africa. All NAAT-positive participants were recalled to the clinics for further management. Vertical transmission was assessed among exposed infants whose HIV polymerase chain reaction (PCR) results were available.

Results

This study enrolled 8208 pregnant participants who tested negative on rapid HIV tests between 2013 and 2016. Their median age was 26 years (interquartile range [IQR]: 23–30). NAAT detected HIV infections in 0.6% (n = 49; 95% confidence interval {CI}: 0.5–0.8) of all study participants. The distribution of these infections among the four clinics ranged from 0.3%– 1.1%, but this was not statistically significant (p = 0.07). Forty-seven participants (95.9%) were successfully recalled and referred for antiretroviral treatment initiation as part of prevention of MTCT (PMTCT). Most women with newly diagnosed HIV infection presented for the first ANC visit in the second (61.9%, n = 26) and third (31.0%, n = 13) trimesters. HIV PCR results were available for thirty-two infants, three of whom tested positive (9.4%; 95% CI: 1.98–25.02).

Conclusions

This study showed that supplemental HIV testing for pregnant women led to earlier linkage to the PMTCT programme. Inaccurate diagnosis of HIV infection at ANC clinics is likely to undermine the efforts of eliminating MTCT particularly in HIV-endemic settings.

Klíčová slova:

Antenatal care – Enzyme-linked immunoassays – HIV diagnosis and management – HIV infections – Infants – Polymerase chain reaction – Pregnancy


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