Challenges of Discrepant HIV Tests in Pregnant Women in the PrEP era-to Treat or Not to Treat?

J Infect Dis. 2021 Feb 3;223(2):234-237. doi: 10.1093/infdis/jiaa343.

Abstract

Background: During HIV retesting in antenatal and preexposure prophylaxis (PrEP) care, discrepant results occur, but guidelines are lacking.

Methods: In a Kenyan trial implementing antenatal PrEP, if 1 test is reactive, a second is performed; if discrepant, both are repeated; if persistently discrepant, DNA polymerase chain reaction (PCR) is performed.

Results: Among 4451 women, 23 265 HIV retesting sessions were performed; 14 (0.06%, 95% confidence interval, 0.03%-0.10%) had discrepant results among 10 individuals; in all 10 initial cases, PCR was negative.

Conclusions: Discrepant rapid tests are an expected, rare, and important challenge for antenatal care HIV retesting, with and without PrEP.

Clinical trials registration: NCT03070600.

Keywords: HIV retesting; discrepant results; indeterminate results; peripartum; preexposure prophylaxis; pregnancy; repeat HIV testing.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active
  • Clinical Decision-Making
  • Disease Management
  • Female
  • HIV Infections / diagnosis*
  • HIV Infections / drug therapy
  • HIV Infections / prevention & control
  • HIV Infections / virology*
  • HIV* / genetics
  • Humans
  • Kenya
  • Mass Screening
  • Polymerase Chain Reaction
  • Pre-Exposure Prophylaxis* / methods
  • Pregnancy
  • Pregnancy Complications, Infectious / diagnosis*
  • Pregnancy Complications, Infectious / drug therapy
  • Pregnancy Complications, Infectious / prevention & control
  • Pregnancy Complications, Infectious / virology*
  • Prenatal Care

Substances

  • Anti-HIV Agents

Associated data

  • ClinicalTrials.gov/NCT03070600