HIV RNA testing in the context of nonoccupational postexposure prophylaxis

The Journal of Infectious Diseases
Michelle E RolandJeffrey N Martin

Abstract

The specificity and positive predictive value of human immunodeficiency virus (HIV) RNA assays have not been evaluated in the setting of postexposure prophylaxis (PEP). Plasma from subjects enrolled in a nonoccupational PEP study was tested with 2 branched-chain DNA (bDNA) assays, 2 polymerase chain reaction (PCR) assays, and a transcription-mediated amplification (TMA) assay. Assay specificity and positive predictive value were determined for subjects who remained negative for HIV antibody for >or=3 months. In 329 subjects examined, the lowest specificities (90.1%-93.7%) were seen for bDNA testing performed in real time. The highest specificities were seen with batched bDNA version 3.0 (99.1%), standard PCR (99.4%), ultrasensitive PCR (100%), and TMA (99.6%) testing. Only the 2 assays with the highest specificities had positive predictive values >40%. For the bDNA assays, increasing the cutoff point at which a test is called positive (e.g., from 50 copies/mL to 500 copies/mL for version 3.0) increased both specificity and positive predictive values to 100%. The positive predictive value of HIV RNA assays in individuals presenting for PEP is unacceptably low for bDNA-based testing and possibly acceptable for PCR- and TMA-based ...Continue Reading

Citations

Oct 30, 2009·The New England Journal of Medicine·Raphael J Landovitz, Judith S Currier
May 19, 2006·Expert Review of Molecular Diagnostics·Bernard Weber
Jan 2, 2007·Current Opinion in Infectious Diseases·Michelle E Roland
Sep 1, 2006·Current Opinion in HIV and AIDS·Paul E Sax
Oct 3, 2006·Expert Review of Anti-infective Therapy·Denison ChangElizabeth M Dax

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