THE SENSITIVITY OF HIV-1 DNA-POLYMERASE CHAIN-REACTION IN THE NEONATAL-PERIOD AND THE RELATIVE CONTRIBUTIONS OF INTRAUTERINE AND INTRA-PARTUM TRANSMISSION

Objective: To derive reliable estimates of the sensitivity of HIV-1 DN A polymerase chain reaction (PCR) in the neonatal period and to quanti fy the relative contributions of intra-uterine and intra-partum transm ission. Methods: After reviewing studies on the early diagnosis of HIV -1 infection, investigators were asked to provide published and unpubl ished PCR test results on prospectively followed, non-breastfed, verti cally infected children. Age-specific estimates of the sensitivity of PCR were derived using distribution-free methods for interval-censored data. Results: Data on 271 infected children were combined for analys is. PCR detected HIV-1 DNA in an estimated 38% [90% confidence interva l (CI), 29-46] of HIV-infected children tested on the day of, or day a fter, birth. Sensitivity was observed to rise rapidly in the second we ek of life, reaching 93% (90% CI, 76-97) by 14 days of age. Conclusion : The sensitivity of PCR in the neonatal period is higher than previou sly reported. This affects the clinical interpretation of an early neg ative test result and encourages the use of PCR as an endpoint for tri als to evaluate interventions to reduce vertical transmission in non-b reastfed populations. Approximately one-third of vertically acquired H IV-1 infection could be attributable to intra-uterine transmission.