{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:51:33Z","timestamp":1791215493740,"version":"4.1.0"},"reference-count":26,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","ijidonline.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Infectious Diseases"],"published-print":{"date-parts":[[2026,9]]},"DOI":"10.1016\/j.ijid.2026.108929","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T23:39:02Z","timestamp":1782517142000},"page":"108929","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Reactive Fourth-Generation HIV Assays at Low Cut-Off Indices May Be Clinically Misleading in the Obstetric Setting: A Multicenter Analysis of 904 Reactive Cases"],"prefix":"10.1016","volume":"170","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4181-5674","authenticated-orcid":false,"given":"Ezgi","family":"Y\u0131lmaz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuran","family":"Karabulut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ay\u015fe","family":"\u0130stanbullu-Tosun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sema","family":"Ala\u00e7am","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meyha","family":"\u015eahin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eda","family":"Alp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevgi","family":"Alan-Do\u011fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asiye","family":"Yir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esra","family":"Fersan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damla","family":"Akda\u011f","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zlem","family":"G\u00f6k\u00e7e","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berna","family":"Demirok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onur","family":"\u00d6zalp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alper","family":"G\u00fcnd\u00fcz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130brahim","family":"Polat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zlem","family":"Altunta\u015f-Ayd\u0131n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Mert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ijid.2026.108929_sbref0001","series-title":"Global HIV programme [Internet]","year":"2024"},{"issue":"6","key":"10.1016\/j.ijid.2026.108929_bib0002","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1097\/INF.0000000000002290","article-title":"Epidemiology of perinatal HIV transmission in the United States in the era of its elimination","volume":"38","author":"Nesheim","year":"2019","journal-title":"Pediatr Infect Dis J"},{"issue":"4","key":"10.1016\/j.ijid.2026.108929_bib0003","doi-asserted-by":"crossref","first-page":"849","DOI":"10.3390\/v15040849","article-title":"Prevention of the vertical transmission of HIV: a recap of the journey so far","volume":"15","author":"Cardenas","year":"2023","journal-title":"Viruses"},{"key":"10.1016\/j.ijid.2026.108929_bib0005","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jcv.2018.06.017","article-title":"Evaluation of the virtues and pitfalls in an HIV screening algorithm based on two fourth generation assays: a step towards an improved national algorithm","volume":"106","author":"Avidor","year":"2018","journal-title":"J Clin Virol"},{"key":"10.1016\/j.ijid.2026.108929_sbref0006","series-title":"Preventing HIV misdiagnosis [Internet]","year":"2023"},{"key":"10.1016\/j.ijid.2026.108929_sbref0007","series-title":"Anneden bebe\u011fe HIV ge\u00e7i\u015finin \u00f6nlenmesi i\u015f ak\u0131\u015f \u015femas\u0131 [Internet]","year":"2018"},{"issue":"6","key":"10.1016\/j.ijid.2026.108929_bib0008","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1093\/jalm\/jfab069","article-title":"Real-world clinical performance evaluation of a fourth-generation HIV antigen\/antibody differentiation test","volume":"6","author":"Krasowski","year":"2021","journal-title":"J Appl Lab Med"},{"issue":"4","key":"10.1016\/j.ijid.2026.108929_bib0009","doi-asserted-by":"crossref","first-page":"408.e1","DOI":"10.1016\/j.ajog.2018.06.008","article-title":"Diagnostic accuracy of fourth-generation ARCHITECT HIV Ag\/Ab Combo assay and utility of signal-to-cutoff ratio to predict false-positive HIV tests in pregnancy","volume":"219","author":"Adhikari","year":"2018","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ijid.2026.108929_bib0010","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.jviromet.2017.09.005","article-title":"Specificity of two HIV screening tests detecting simultaneously HIV-1 p24 antigen and antibodies to HIV-1 and -2","volume":"249","author":"Blaich","year":"2017","journal-title":"J Virol Methods"},{"issue":"3","key":"10.1016\/j.ijid.2026.108929_bib0011","doi-asserted-by":"crossref","first-page":"210","DOI":"10.5152\/kd.2018.51","article-title":"Does anti-HIV positivity in pregnancy suggest the requirement of HIV prophylaxis for newborn?","volume":"31","author":"Sayan","year":"2018","journal-title":"Klimik Derg"},{"issue":"2","key":"10.1016\/j.ijid.2026.108929_bib0012","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1002\/jcla.21743","article-title":"Clinical application evaluation of two fourth-generation human immunodeficiency virus screening assays in West China Hospital","volume":"29","author":"Liu","year":"2015","journal-title":"J Clin Lab Anal"},{"issue":"1","key":"10.1016\/j.ijid.2026.108929_bib0013","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-025-97169-y","article-title":"HIV testing algorithm using fourth generation reagents reduces the false positive rate of screening tests","volume":"15","author":"Gou","year":"2025","journal-title":"Sci Rep"},{"key":"10.1016\/j.ijid.2026.108929_bib0014","doi-asserted-by":"crossref","DOI":"10.1155\/2022\/5097189","article-title":"An analysis of predictive sample-to-cutoff index for HIV infection confirmation using Elecsys\u00ae HIV Combi PT assay","author":"Xia","year":"2022","journal-title":"Int J Clin Pract"},{"issue":"2","key":"10.1016\/j.ijid.2026.108929_bib0015","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0009382","article-title":"A human immunodeficiency virus screening algorithm to address the high rate of false-positive results in pregnant women in Japan","volume":"5","author":"Shima-Sano","year":"2010","journal-title":"PLoS One"},{"key":"10.1016\/j.ijid.2026.108929_bib0016","doi-asserted-by":"crossref","DOI":"10.3389\/fcimb.2022.877643","article-title":"Clinical application evaluation of Elecsys\u00ae HIV Duo assay in Southwest China","volume":"12","author":"Yang","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"key":"10.1016\/j.ijid.2026.108929_bib0017","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jcv.2018.11.005","article-title":"A multicentre evaluation of the Elecsys\u00ae HIV Duo assay","volume":"112","author":"M\u00fchlbacher","year":"2019","journal-title":"J Clin Virol"},{"key":"10.1016\/j.ijid.2026.108929_bib0018","doi-asserted-by":"crossref","DOI":"10.1155\/jotm\/5111633","article-title":"Challenges in HIV diagnosis algorithm: experience of the confirmation laboratory","volume":"2025","author":"Appak","year":"2025","journal-title":"J Trop Med"},{"issue":"7","key":"10.1016\/j.ijid.2026.108929_bib0019","doi-asserted-by":"crossref","first-page":"ofac259","DOI":"10.1093\/ofid\/ofac259","article-title":"Am I positive? Improving human immunodeficiency virus testing in the era of preexposure prophylaxis and immediate antiretroviral therapy using machine learning","volume":"9","author":"Zucker","year":"2022","journal-title":"Open Forum Infect Dis"},{"issue":"1","key":"10.1016\/j.ijid.2026.108929_bib0020","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1186\/s12879-023-08891-9","article-title":"Using signal-to-cutoff ratios of HIV screening assay to predict HIV infection","volume":"23","author":"Guo","year":"2023","journal-title":"BMC Infect Dis"},{"issue":"5","key":"10.1016\/j.ijid.2026.108929_bib0021","doi-asserted-by":"crossref","DOI":"10.1002\/jcla.22866","article-title":"Sample-to-cutoff ratios using architect HIV Ag\/Ab combo: the influence with the results of supplemental tests and optimal cutoff value to predict HIV infection","volume":"33","author":"Wang","year":"2019","journal-title":"J Clin Lab Anal"},{"key":"10.1016\/j.ijid.2026.108929_bib0022","doi-asserted-by":"crossref","DOI":"10.1016\/j.dib.2021.107549","article-title":"Data on the relationships of signal-to-cutoff ratios of Elecsys HIV antigen\/antibody and Elecsys syphilis assays to subsequent confirmatory testing at an academic medical center","volume":"39","author":"Chopra","year":"2021","journal-title":"Data Brief"},{"issue":"8","key":"10.1016\/j.ijid.2026.108929_bib0023","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1007\/s10096-018-3290-y","article-title":"HIV serology signal-to-cutoff ratio as a rapid method to predict confirmation of HIV infection","volume":"37","author":"Li","year":"2018","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"10.1016\/j.ijid.2026.108929_bib0024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jcv.2019.04.002","article-title":"BioRad BioPlex\u00ae HIV Ag-Ab assay: incidence of false positivity in a low-prevalence population and its effects on the current HIV testing algorithm","volume":"116","author":"Parker","year":"2019","journal-title":"J Clin Virol"},{"key":"10.1016\/j.ijid.2026.108929_bib0025","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jcv.2017.04.003","article-title":"Real-world performance of the new US HIV testing algorithm in medical settings","volume":"91","author":"Marson","year":"2017","journal-title":"J Clin Virol"},{"issue":"12","key":"10.1016\/j.ijid.2026.108929_bib0026","doi-asserted-by":"crossref","first-page":"e01204","DOI":"10.1128\/jcm.01204-22","article-title":"Utility of the signal-to-cutoff ratio and antigen index from fourth- and fifth-generation HIV-1\/HIV-2 antigen\/antibody assays for the diagnosis of acute HIV infection: applicability for real-time use for immediate initiation of antiretroviral therapy","volume":"60","author":"Whitney","year":"2022","journal-title":"J Clin Microbiol"},{"issue":"Suppl 1","key":"10.1016\/j.ijid.2026.108929_bib0027","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1016\/j.jcv.2013.08.014","article-title":"Performance of an alternative HIV diagnostic algorithm using the ARCHITECT HIV Ag\/Ab combo assay and potential utility of sample-to-cutoff ratio to discriminate primary from established infection","volume":"58","author":"Ramos","year":"2013","journal-title":"J Clin Virol"}],"container-title":["International Journal of Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1201971226005643?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1201971226005643?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:00:35Z","timestamp":1791212435000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1201971226005643"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":26,"alternative-id":["S1201971226005643"],"URL":"https:\/\/doi.org\/10.1016\/j.ijid.2026.108929","relation":{},"ISSN":["1201-9712"],"issn-type":[{"value":"1201-9712","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Reactive Fourth-Generation HIV Assays at Low Cut-Off Indices May Be Clinically Misleading in the Obstetric Setting: A Multicenter Analysis of 904 Reactive Cases","name":"articletitle","label":"Article Title"},{"value":"International Journal of Infectious Diseases","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ijid.2026.108929","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.","name":"copyright","label":"Copyright"}],"article-number":"108929"}}