Inwani I., Mbori-Ngacha D., Nduati R., Obimbo E., Wamalwa D., John-Stewart G., Farquhar C.
Department of Paediatrics, Kenyatta National Hospital, Box 29720, Hospital Road, Nairobi 00202, Kenya; Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya; Departments of Medicine, University of Washington, Seattle, WA, United States; Departments of Epidemiology, University of Washington, Seattle, WA, United States
Inwani, I., Department of Paediatrics, Kenyatta National Hospital, Box 29720, Hospital Road, Nairobi 00202, Kenya; Mbori-Ngacha, D., Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya; Nduati, R., Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya; Obimbo, E., Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya; Wamalwa, D., Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya; John-Stewart, G., Departments of Medicine, University of Washington, Seattle, WA, United States, Departments of Epidemiology, University of Washington, Seattle, WA, United States; Farquhar, C., Departments of Medicine, University of Washington, Seattle, WA, United States, Departments of Epidemiology, University of Washington, Seattle, WA, United States
BACKGROUND:: Ninety percent of HIV-1-infected children live in sub-Saharan Africa. In the absence of diagnosis and antiretroviral therapy, approximately 50% die before 2 years. METHODS:: We evaluated sensitivity and specificity of clinical algorithms for diagnosis of HIV-1 infection and antiretroviral therapy initiation among HIV-1-exposed children aged less than 18 months. Children were identified with routine HIV-1 testing and assessed using 3 sets of criteria: (1) Integrated Management of Childhood Illnesses (IMCI), (2) World Health Organization Presumptive Diagnosis (WHO-PD) for HIV-1 infection, and (3) CD4 T-lymphocyte cell subsets. HIV-1 infection status was determined using DNA polymerase chain reaction testing. FINDINGS:: A total of 1418 children (median age 5.4 months) were screened for HIV-1 antibodies, of whom 144 (10.2%) were seropositive. Of these, 134 (93%) underwent HIV-1 DNA testing and 80 (60%) were found to be HIV-1 infected. Compared with HIV-1 DNA testing, sensitivity and specificity of the IMCI criteria were 19% and 96% and for WHO-PD criteria 43% and 88%, respectively. Inclusion of severe immune deficiency determined by CD4% improved sensitivity of IMCI and WHO-PD criteria to 74% and 84%, respectively; however, specificity declined to 43% and 41%, respectively. INTERPRETATION:: Diagnosis of HIV-1 infection among exposed children less than 18 months in a high-prevalence resource-limited setting remains a challenge, and current recommended algorithms have low sensitivity. This underscores the need for rapid scale-up of viral assays for early infant diagnosis. Copyright © 2009 by Lippincott Williams & Wilkins.
