Screening for 'window-period' acute HIV infection among pregnant women in rural South Africa.
OBJECTIVE
The aim of this study was to evaluate the HIV-1 RNA pooled nucleic acid amplification testing (NAAT) strategy to screen pregnant women in the 'window period' of acute HIV infection (AHI) in rural South Africa.


METHODS
In 2007 and 2008, 750 consecutive pregnant women on their first antenatal care visit to a primary health care clinic were tested anonymously for HIV infection. HIV-1 RNA pooled NAAT was performed on HIV antibody-negative samples. All positive pools were tested individually and positive samples were classified as incident cases to calculate HIV incidence.


RESULTS
The overall HIV prevalence was 37.3% [95% confidence interval (CI) 34.3–41.3]. Of the 467 HIV antibody-negative samples, four (0.9%) were HIV-1 RNA-positive. The mean viral load in the four samples was 386 260 HIV-1 RNA copies/mL (range 64 200–1 228130). The HIV incidence was 11.2%per year (95% CI 0.3–22.1) and all women with AHI were 21 years of age.


CONCLUSIONS
Identifying AHI in pregnancy is important for health interventions to reduce perinatal and heterosexual transmission of HIV, and to estimate HIV incidence for epidemiological surveillance.
Kharsany
A B M
AB
Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. kharsany@ukzn.ac.za
Hancock
N
N
Frohlich
J A
JA
Humphries
H R
HR
Abdool Karim
S S
SS
Abdool Karim
Q
Q
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000379:methods; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015483:HIV Antibodies; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D015994:Incidence; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D021141:Nucleic Acid Amplification Techniques; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D012367:RNA, Viral / Q000032:analysis; D012424:Rural Population; D013019:South Africa; D019562:Viral Load; D055815:Young Adult
D015483:HIV Antibodies; D012367:RNA, Viral