HIV misdiagnosis

False-negative HIV tests using oral fluid tests in children taking antiretroviral therapy from Harare, Zimbabwe

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Author
Ioana D. Olaru, Grace McHugh, Suba Dakshina, Edith Majonga, Ethel Dauya, Tsitsi Bandason, Katharina Kranzer, Hilda Mujuru, Rashida Ferrand

Rapid diagnostic tests (RDT) for HIV infection have high sensitivity and specificity, but in the setting of longstanding antiretroviral therapy (ART), can give false results that can lead to misinterpretation, confusion and inadequate management. The objective of this study was to evaluate the proportion of falsely negative results of a RDT performed on oral fluid in HIV-infected children on longstanding ART.

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Misdiagnosed HIV infection in pregnant women initiating universal ART in South Africa

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Yes
Author
Nei-yuan Hsiao, Allison Zerbe, Tamsin K. Phillips, Landon Myer, Elaine J. Abrams

Rapid diagnostic tests (RDTs) are the primary diagnostic tools for HIV used in resource-constrained settings. Without a proper confirmation algorithm, there is concern that false-positive (FP) RDTs could result in misdiagnosis of HIV infection and inappropriate antiretroviral treatment (ART) initiation, but programmatic data on FP are few.

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Identification of misdiagnosed HIV clients in an Early Access to ART for All implementation study in Eswatini

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Yes
Author
Shaukat Khan, Emma Mafara, Munyaradzi Pasipamire, Donna Spiegelman, Sikhathele Mazibuko, Nombuso Ntshalintshali, Anita Hettema, Charlotte Lejeune, Fiona Walsh, Velephi Okello

Rapid diagnostic testing has made HIV diagnosis and subsequent treatment more accessible. However, multiple factors, including improper implementation of testing strategies and clerical errors, have been reported to lead to HIV misdiagnosis. The World Health Organization has recommended HIV retesting prior to antiretroviral therapy (ART) initiation which has become pertinent with scaling up of Early Access to ART for All (EAAA). In this analysis, misdiagnosed clients are identified from a subgroup of clients enrolled in EAAA implementation study in Swaziland.

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Misdiagnosis of HIV infection during a South African community-based survey: implications for rapid HIV testing

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Yes
Author
Tendesayi Kufa, Ayesha BM Kharsany, Cherie Cawood, David Khanyile, Lara Lewis, Anneke Grobler, Zawadi Chipeta, Alfred Bere, Mary Glenshaw, Adrian Puren

This study describes the overall accuracy and performance of a serial rapid HIV testing algorithm used in community-based HIV testing in the context of a population-based household survey conducted in two sub-districts of uMgungundlovu district, KwaZulu-Natal, South Africa, against reference fourth-generation HIV-1/2 antibody and p24 antigen combination immunoassays. We discuss implications of the findings on rapid HIV testing programmes.

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Prevalence and outcomes of HIV-1 diagnostic challenges during universal birth testing – an urban South African observational cohort

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Yes
Author
Karl-Günter Technau, Ahmad Haeri Mazanderani, Louise Kuhn, Lucia Hans, Renate Strehlau, Elaine J. Abrams, Martie Conradie, Ashraf Coovadia, Ndileka Mbete, Pamela M. Murnane, Faeezah Patel, Stephanie Shiau, Caroline T. Tiemessen, Gayle G. Sherman

HIV-1 polymerase chain reaction (PCR) testing at birth aims to facilitate earlier initiation of antiretroviral therapy (ART) for HIV-infected neonates. Data from two years of universal birth testing implementation in a high-burden South African urban setting are presented to demonstrate the prevalence and outcomes of diagnostic challenges in this context.

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To err is human, to correct is public health: a systematic review examining poor quality testing and misdiagnosis of HIV status

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Yes
Author
Cheryl C. Johnson, Virginia Fonner, Anita Sands, Nathan Ford, Carla Makhlouf Obermeyer, Sharon Tsui, Vincent Wong, Rachel Baggaley

In accordance with global testing and treatment targets, many countries are seeking ways to reach the “90-90-90” goals, starting with diagnosing 90% of all people with HIV. Quality HIV testing services are needed to enable people with HIV to be diagnosed and linked to treatment as early as possible. It is essential that opportunities to reach people with undiagnosed HIV are not missed, diagnoses are correct and HIV-negative individuals are not inadvertently initiated on life-long treatment.

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JIAS Supplement: Programmatic and public health implications of misdiagnosis of HIV

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The Journal of the International AIDS Society just launched a supplement entitled ‘Programmatic and public health implications of misdiagnosis of HIV’. This supplement was guest edited by Cheryl C. Johnson (World Health Organization), Shona Dalal (World Health Organization) and Miriam Taegtmeyer (Liverpool School of Tropical Medicine).

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Reaching the 90-90-90 Targets: The Implications of HIV Misdiagnosis

Venue
Webinar

Attaining UNAIDS' 90-90-90 targets largely depends on the first 90 – correctly diagnosing 90 percent of all people living with HIV.  Join AIDSFree for a webinar on October 13, 2016 from 9:00 a.m. – 10:30 a.m. EST where presenters will highlight the evidence collected on HIV misdiagnosis and discuss the ethical, legal, human rights, and public health implications.

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