title: Performance of a parallel diagnostic algorithm for HIV diagnosis in low risk pediatric and obstetric patient populations.
abstract: BACKGROUND
  Little is known about the clinical performance of the 2010 APHL/CDC Western-blot independent HIV testing algorithm in low risk pediatric and obstetric patients.
  
  
  OBJECTIVE
  To evaluate the performance of an alternate Western-blot independent algorithm and the individual algorithm components in diagnosing HIV infections in low risk pediatric and obstetric patients.
  
  
  METHODS
  6242 specimens from pediatric and obstetric patients were tested by the Bio-Rad Multispot HIV-1/HIV-2 (MS) and VITROS Anti HIV 1+2 (VITROS) assays. 913 specimens were also tested by the ARCHITECT HIV Ag/Ab Combo assay (ARCHITECT). Discordant specimens were tested by the APTIMA HIV-1 RNA qualitative assay (RNA Qual).
  
  
  RESULTS
  Twenty-eight specimens tested positive for HIV-1 by both MS and VITROS, 4 of these 28 specimens were also tested by and positive by ARCHITECT; all 28 positives identified by the algorithm were positive by viral load analysis. MS identified 164 preliminary positives, which were not confirmed as true positives, representing a specificity of 97.4%. This specificity varied between patient populations (96.1% in the pediatric population and 99.1% in the obstetric population). The specificities of VITROS and ARCHITECT were 99.2% and 99.4% for pediatric patients; 99.7% and 99.8% for obstetric patients, respectively.
  
  
  CONCLUSIONS
  Our results highlight suboptimal specificity of MS in pediatric patients, and a lower specificity in both pediatric and obstetric patients relative to either VITROS or ARCHITECT. Additionally, parallel testing with both a third and fourth generation EIA in a low risk patient population provides a potential alternative to Western-blot dependent algorithms for confirmation.
authors.affiliation: Department of Pathology, Baylor College of Medicine, Houston, TX 77030, United States; Department of Pathology, Texas Children's Hospital, Houston, TX 77030, United States.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Chandramohan
authors.affiliation: Department of Pathology, Texas Children's Hospital, Houston, TX 77030, United States.
authors.forename: German
authors.initials: G
authors.lastname: Vargas
authors.affiliation: Department of Pathology, Texas Children's Hospital, Houston, TX 77030, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Dowlin
authors.affiliation: Department of Pathology, Baylor College of Medicine, Houston, TX 77030, United States; Department of Pathology, Texas Children's Hospital, Houston, TX 77030, United States.
authors.forename: Shweta
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Pathology, Baylor College of Medicine, Houston, TX 77030, United States; Department of Pathology, Texas Children's Hospital, Houston, TX 77030, United States.
authors.forename: Gregory
authors.initials: G
authors.lastname: Buffone
authors.affiliation: Department of Pathology, Baylor College of Medicine, Houston, TX 77030, United States; Department of Pathology, Texas Children's Hospital, Houston, TX 77030, United States.
authors.forename: Sridevi
authors.initials: S
authors.lastname: Devaraj
authors.affiliation: Department of Pathology, Baylor College of Medicine, Houston, TX 77030, United States; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States; Department of Pathology, Texas Children's Hospital, Houston, TX 77030, United States. Electronic address: parevell@texaschildrenshospital.org.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Revell
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D009774:Obstetrics / Q000379:methods; D010372:Pediatrics / Q000379:methods; D012680:Sensitivity and Specificity
keywords: HIV diagnosis; Low risk; Obstetric; Pediatric