title: HIV-1 ICD p24 antigen detection in ugandan infants: use in early diagnosis of infection and as a marker of disease progression.
abstract: The objective of this study was to determine the use of immune-complex dissociated (ICD) p24 antigen detection for the diagnosis and prognosis of HIV-1 infection in Ugandan children. Plasma collected prospectively from children born to HIV-1 infected Ugandan women was stored and later analyzed for the presence of neutralizable HIV-1 p24 antigen using the Coulter ICD p24 antigen and neutralization kits. HIV-1 infection status, disease progression, and survival of the children were determined. Specimens from 311 children born to HIV-1 infected women, including 138 HIV-1 infected children, and 113 children born to negative women were tested. Sixty-nine (50%) infected children were p24 antigen positive at least once. For early HIV-1 diagnosis, the specificity and positive predictive value of the assay were consistently high (>95% and >83% respectively), but the sensitivity was low (6-53%), especially in the first months of life. The presence of p24 antigenemia in the first two years of life was associated with poor survival (20%) by 80 months of age compared with infected children without antigenemia (43%, P < 0.001). Early detection of p24 antigen (</=2 months) was associated with higher mortality than first detection at an older age (>6 months, P < 0.001). The data suggest that ICD p24 antigen detection is not a sensitive method for the determination of infant HIV-1 status in our cohort of HIV-1 infected Ugandan children tested in the first two years of life. There was a strong correlation, however, between the presence and time of onset of p24 antigenemia and mortality among HIV-1 infected children.
authors.affiliation: Department of Pathology, The Johns Hopkins University, Baltimore, Maryland 21287, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Guay
authors.forename: D L
authors.initials: DL
authors.lastname: Hom
authors.forename: S R
authors.initials: SR
authors.lastname: Kabengera
authors.forename: E M
authors.initials: EM
authors.lastname: Piwowar-Manning
authors.forename: P
authors.initials: P
authors.lastname: Kataaha
authors.forename: C
authors.initials: C
authors.lastname: Ndugwa
authors.forename: L H
authors.initials: LH
authors.lastname: Marum
authors.forename: I
authors.initials: I
authors.lastname: Kalyesubula
authors.forename: J B
authors.initials: JB
authors.lastname: Jackson
mesh_terms: D015415:Biomarkers; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D016655:HIV Core Protein p24 / Q000097:blood* / Q000276:immunology; D015658:HIV Infections / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology / Q000821:virology; D015497:HIV-1 / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology; D011446:Prospective Studies; D014454:Uganda
chemical_list: D015415:Biomarkers; D016655:HIV Core Protein p24