DIAGNOSIS OF PERINATAL HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION BY POLYMERASE CHAIN-REACTION AND P24 ANTIGEN-DETECTION AFTER IMMUNE-COMPLEX DISSOCIATION IN AN URBAN-COMMUNITY HOSPITAL

Results of polymerase chain reaction (PCR) and p24 antigen detection a fter immune complex dissociation (p24-ICD) were compared with antibody results after 18 months of age for human immunodeficiency virus (HIV) diagnosis in 345 prospectively followed, perinatally exposed infants. Of 59 infected and 286 uninfected infants tested at 1-6 months of age , sensitivity and specificity were, respectively, 100% and >97% for PC R and 90% and >97% for p24-ICD. Testing was done on greater than or eq ual to 2 occasions in the first 6 months of life in 43 infected infant s; 77% had greater than or equal to 2 positive results with the same t est. Of these infants, 68% had 2 positive p24-ICD tests. In uninfected infants, 96% had only negative tests; none had >1 positive. By 6 mont hs, all uninfected infants with greater than or equal to 2 PCR results could have been diagnosed. HIV status can be determined by PCR by age 6 months in most HIV-exposed infants. p24-ICD should not be used alon e, because of its lower sensitivity, but may be useful in areas withou t advanced laboratory support.