title: False-negative post-18-month confirmatory HIV tests in HIV DNA PCR-positive children:  a retrospective analysis.
abstract: OBJECTIVE
  The WHO guidelines for children less than 18 months old diagnosed with HIV based on presumptive clinical diagnosis or one virologic test recommend confirmatory HIV antibody testing after 18 months of age. This study describes post-18-month HIV test results following this WHO-recommended confirmatory testing strategy.
  
  
  METHODS
  Case series and retrospective review of routine program data.
  
  
  METHODS
  Children enrolled at the Baylor Children's Clinical Center of Excellence, a pediatric and family HIV clinic in Maseru, Lesotho from December 2005 through January 2009 with a positive HIV DNA PCR at less than 18 months of age and HIV rapid test results after 18 months of age were included. Post-18-month confirmatory HIV test results are described. Factors associated with non-positive confirmatory rapid tests were determined using binary logistic regression.
  
  
  RESULTS
  Of the 109 children meeting inclusion criteria, 22 (20.2%) had negative and 27 (24.8%) discordant confirmatory rapid tests. Forty-six of these 49 were on antiretroviral therapy (ART). Among these 49, 11 of 24 post-18-month HIV DNA PCRs were negative, whereas nine of 10 post-18-month HIV ELISAs were positive; 29 were definitively and 17 probably HIV-infected, two were uninfected, and one had undetermined status. Only age less than 9 months at ART initiation (odds ratio 4.25, P = 0.002) was associated with non-positive rapid tests.
  
  
  CONCLUSIONS
  False-negative post-18-month confirmatory rapid tests and HIV DNA PCRs in children on ART are common, associated with early ART initiation, and may lead to inappropriate ART discontinuation and discharge from care of truly HIV-infected children.
authors: Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital (BIPAI), Texas Children's Hospital, Houston, TX 77030, USA. to.tonygp@gmail.com
authors: Anthony J
authors: AJ
authors: Garcia-Prats
authors: Heather R
authors: HR
authors: Draper
authors: Jill E
authors: JE
authors: Sanders
authors: Anurag K
authors: AK
authors: Agrawal
authors: Edith Q
authors: EQ
authors: Mohapi
authors: Gordon E
authors: GE
authors: Schutze
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage*; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification*; D004334:Drug Administration Schedule; D005188:False Negative Reactions; D005260:Female; D006678:HIV / Q000235:genetics*; D015483:HIV Antibodies / Q000235:genetics*; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007927:Lesotho / Q000453:epidemiology; D008297:Male; D021141:Nucleic Acid Amplification Techniques; D016133:Polymerase Chain Reaction / Q000379:methods; D011933:Reagent Kits, Diagnostic; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents; D004279:DNA, Viral; D015483:HIV Antibodies; D011933:Reagent Kits, Diagnostic