title: A human immunodeficiency virus screening algorithm to address the high rate of false-positive results in pregnant women in Japan.
abstract: BACKGROUND
  Prenatal human immunodeficiency virus (HIV) testing is essential for the prevention of mother-to-child transmission. However, false-positive results of screening testing are a concern as they may cause unnecessary emotional stress to pregnant women waiting for confirmatory test results. In regions with an extremely low prevalence, the positive predictive values of screening are unacceptably low rate. Here, we propose a HIV screening algorithm consisting of serial two fourth-generation enzyme immunoassays to reduce the number of false-positive screening results.
  
  
  RESULTS
  When 6461 pregnant women presenting to two maternity hospitals located in the Tokyo metropolitan area of Japan from September, 2004 to January, 2006 were tested using Enzygnost HIV Integral as a first screening test, 27 showed positive reactions. When these positive reaction samples were tested using VIDAS HIV DUO Quick as a second screening test, only one of them had a positive reaction, and the remaining 26 were nonreactive. Confirmatory Western blots and nucleic acid amplification test also showed that one was positive and the remaining 26 were negative; the subject who was positive with the confirmatory tests was identical to the subject who was positive with the second screening test. Thus, by adding the second screening test, the false-positive rate was improved from 0.4% to 0%, and the positive predictive value from 3.7% to 100%, compared with the single screening test.
  
  
  CONCLUSIONS
  By applying our serial screening algorithm to HIV testing in maternity hospitals, many uninfected pregnant women would not need to receive confirmatory tests and be subjected to emotional turmoil while waiting for their confirmatory test results. This algorithm would be suitable for HIV testing of pregnant women living in low prevalence regions such as Japan.
authors.affiliation: Division of Microbiology, Kanagawa Prefectural Institute of Public Health, Kanagawa, Japan. sano.ipn@pref.kanagawa.jp
authors.forename: Takako
authors.initials: T
authors.lastname: Shima-Sano
authors.forename: Rika
authors.initials: R
authors.lastname: Yamada
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Sekita
authors.forename: Raleigh W
authors.initials: RW
authors.lastname: Hankins
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Hori
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Seto
authors.forename: Koji
authors.initials: K
authors.lastname: Sudo
authors.forename: Makiko
authors.initials: M
authors.lastname: Kondo
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kawahara
authors.forename: Yuki
authors.initials: Y
authors.lastname: Tsukahara
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Inaba
authors.forename: Shingo
authors.initials: S
authors.lastname: Kato
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Imai
mesh_terms: D000465:Algorithms; D015153:Blotting, Western; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006678:HIV / Q000145:classification / Q000276:immunology / Q000378:metabolism; D015483:HIV Antibodies / Q000097:blood / Q000276:immunology; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008403:Mass Screening / Q000379:methods*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000821:virology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014041:Tokyo
chemical_list: D015483:HIV Antibodies