A Human Immunodeficiency Virus Screening Algorithm to Address the High Rate of False-Positive Results in Pregnant Women in Japan

• Published in: PloS one Vol. 5; no. 2; p. e9382
• Main Authors: Shima-Sano, Takako, Yamada, Rika, Sekita, Kazuyo, Hankins, Raleigh W., Hori, Hiromasa, Seto, Hiroshi, Sudo, Koji, Kondo, Makiko, Kawahara, Kazuo, Tsukahara, Yuki, Inaba, Noriyuki, Kato, Shingo, Imai, Mitsunobu
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23.02.2010; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; AIDS; Algorithms; Antigens; Automation; Blotting, Western; Cesarean section; Child; Children & youth; Emotions; Enzyme-Linked Immunosorbent Assay; Enzymes; Female; Gynecology; Health risk assessment; Health sciences; Health screening; HIV; HIV - classification; HIV - immunology; HIV - metabolism; HIV Antibodies - blood; HIV Antibodies - immunology; HIV Infections - blood; HIV Infections - diagnosis; HIV Infections - virology; HIV tests; Hospitals; Human immunodeficiency virus; Humans; Immunoassays; Immunology; Infections; Infectious Disease Transmission, Vertical - prevention & control; Infectious Diseases/HIV Infection and AIDS; Laboratories; Mass Screening - methods; Medical diagnosis; Medical tests; Mens health; Metropolitan areas; Nucleic acids; Obstetrics; Obstetrics/Pregnancy; Performance evaluation; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - virology; Pregnant women; Public health; Public Health and Epidemiology/Infectious Diseases; Public Health and Epidemiology/Screening; Reproducibility of Results; Screening; Sensitivity and Specificity; Stress (Psychology); Tokyo; Virology/Immunodeficiency Viruses; Viruses; Western blotting; Women's Health/Sexually Transmitted Diseases; Tokyo; United States > US; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0009382

Prenatal human immunodeficiency virus (HIV) testing is essential for the prevention of mother-to-child transmission. However, false-positive results of screening testing are a concern as they may cause unnecessary emotional stress to pregnant women waiting for confirmatory test results. In regions with an extremely low prevalence, the positive predictive values of screening are unacceptably low rate. Here, we propose a HIV screening algorithm consisting of serial two fourth-generation enzyme immunoassays to reduce the number of false-positive screening results. When 6461 pregnant women presenting to two maternity hospitals located in the Tokyo metropolitan area of Japan from September, 2004 to January, 2006 were tested using Enzygnost HIV Integral as a first screening test, 27 showed positive reactions. When these positive reaction samples were tested using VIDAS HIV DUO Quick as a second screening test, only one of them had a positive reaction, and the remaining 26 were nonreactive. Confirmatory Western blots and nucleic acid amplification test also showed that one was positive and the remaining 26 were negative; the subject who was positive with the confirmatory tests was identical to the subject who was positive with the second screening test. Thus, by adding the second screening test, the false-positive rate was improved from 0.4% to 0%, and the positive predictive value from 3.7% to 100%, compared with the single screening test. By applying our serial screening algorithm to HIV testing in maternity hospitals, many uninfected pregnant women would not need to receive confirmatory tests and be subjected to emotional turmoil while waiting for their confirmatory test results. This algorithm would be suitable for HIV testing of pregnant women living in low prevalence regions such as Japan.