Diener L.C., Slyker J.A., Gichuhi C., Tapia K.A., Richardson B.A., Wamalwa D., Farquhar C., Overbaugh J., Maleche-Obimbo E., John-Stewart G.
Department of Global Health, University of Washington, Seattle, WA, United States; Thematic Unit of Pharmacology, Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya; Department of Biostatistics, University of Washington, Seattle, WA, United States; Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, United States; Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Diener, L.C., Department of Global Health, University of Washington, Seattle, WA, United States; Slyker, J.A., Department of Global Health, University of Washington, Seattle, WA, United States; Gichuhi, C., Thematic Unit of Pharmacology, Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya; Tapia, K.A., Department of Global Health, University of Washington, Seattle, WA, United States; Richardson, B.A., Department of Biostatistics, University of Washington, Seattle, WA, United States; Wamalwa, D., Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya; Farquhar, C., Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, United States; Overbaugh, J., Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, United States; Maleche-Obimbo, E., Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya; John-Stewart, G., Department of Global Health, University of Washington, Seattle, WA, United States
OBJECTIVES: Early infant HIV-1 diagnosis and treatment substantially improve survival. Where virologic HIV-1 testing is unavailable, integrated management of childhood illness (IMCI) clinical algorithms may be used for infant HIV-1 screening. We evaluated the performance of the 2008 WHO IMCI HIV algorithm in a cohort of HIV-exposed Kenyan infants. METHODS: From 1999 to 2003, 444 infants had monthly clinical assessments and quarterly virologic HIV-1 testing. Using archived clinical data, IMCI sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using virologic testing as a gold standard. Linear regression and survival analyses were used to determine the effect of age on IMCI performance and timing of diagnosis. RESULTS: Overall IMCI sensitivity, specificity, PPV, and NPV value were 58, 87, 52, and 90%, respectively. Sensitivity (1.4%) and PPV (14%) were lowest at 1 month of age, when 81% of HIV infections already had occurred. Sensitivity increased with age (P<0.0001), but remained low throughout infancy (range 1.4-35%). Specificity (range 97-100%) was high at each time point and was not associated with age. Fifty-eight percent of HIV-1-infected infants (50 of 86) were eventually diagnosed by IMCI, and use of IMCI was estimated to delay diagnosis in HIV-infected infants by a median of 5.9 months (P<0.0001). CONCLUSION: IMCI had low sensitivity during the first month of life, when the majority of HIV-1 infections had already occurred and initiation of treatment is most critical. Although sensitivity increased with age, the substantial delay in HIV-1 diagnosis using IMCI limits its utility in early infant HIV-1 diagnosis. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Africa; algorithm; article; female; gold standard; human; Human immunodeficiency virus 1 infection; infant; infant disease; major clinical study; performance; prediction; priority journal; sensitivity and specificity; virus diagnosis; Algorithms; Anti-HIV Agents; Breast Feeding; Candidiasis, Oral; Child Health Services; Delivery of Health Care, Integrated; Female; Guidelines as Topic; HIV Infections; HIV-1; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Kenya; Lymphatic Diseases; Male; Mass Screening; Pneumonia; Pregnancy; Prevalence; Risk Factors; Sensitivity and Specificity; World Health Organization