{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:16:18Z","timestamp":1781828178284,"version":"3.54.5"},"reference-count":16,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,6,1]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Early HIV testing is needed for treatment success in young infants, but universal testing is expensive. In this study, we examined the feasibility of early infant HIV risk scores for targeted polymerase chain reaction (PCR) testing and early HIV diagnosis.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n A cross-sectional cohort of newborns exposed to HIV was enrolled and PCR tested within 72 hours. We quantified associations between HIV infection and clinical and laboratory maternal-infant parameters by logistic regression models and determined sensitivity and specificity for derived risk scores.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n From August 2014 to December 2016, 1759 participants were enrolled. Mothers without antenatal care (5.7% [97 of 1688]) were more likely to deliver newborns who are PCR-positive (P = .0005). A total of 1 in 5 mothers (217 of 990; 21.9%) had HIV viral load (VL) &gt;1000 copies per \u00b5L. A total of 432 of 1655 (26.1%) infants were preterm. Low birth weight was documented in 398 of 1598 (24.55%) and 13 of 31 (40.63%) newborns who are PCR-negative and -positive, respectively (P = .0329). A total of 204 of 1689 (12.08%) were growth restricted or small for gestational age, and 6 of 37 (16.22%) were PCR-positive. Symptomatic newborns frequently tested positive (P = .0042). The HIV PCR positivity rate was 2.2% (37 of 1703). Two-risk (combined 3-drug antiretroviral therapy [cART] duration, VL), 3-risk (cART duration, VL, symptomatic newborn), and 4-risk (cART duration, VL, symptomatic, small for gestational age newborn) models for HIV acquisition had predictive probability of 0.28, 0.498, and 0.57, respectively; this could guide targeted birth testing. However, using the 3- and 4-risk scores (probability 0.02 and 0.04), 20% and 24% will be missed compared with universal testing.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Targeted newborn testing requires access to maternal VL. Even if risk models include parameters such as maternal cART history, birth weight, weeks\u2019 gestation, and symptoms, 1 in 5 newborns who are infected will not be targeted. At present, we support universal PCR testing at birth within the South African prevention of mother-to-child transmission of HIV context.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2018-3834","type":"journal-article","created":{"date-parts":[[2019,5,17]],"date-time":"2019-05-17T12:15:14Z","timestamp":1558095314000},"source":"Crossref","is-referenced-by-count":8,"title":["An Early Infant HIV Risk Score for Targeted HIV Testing at Birth"],"prefix":"10.1542","volume":"143","author":[{"given":"Nicolette M.","family":"Du Plessis","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Faculty of Health Sciences and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris J.B.","family":"Muller","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science, University of Stellenbosch, Stellenbosch, South Africa; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theunis","family":"Avenant","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Faculty of Health Sciences and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Pepper","sequence":"additional","affiliation":[{"name":"Department of Immunology, SAMRC Extramural Unit for Stem Cell Research and Therapy, Institute for Cellular and Molecular Medicine, University of Pretoria, Pretoria, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameena E.","family":"Goga","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Faculty of Health Sciences and"},{"name":"Health Systems Research Unit, South African Medical Research Council, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2019,6,1]]},"reference":[{"issue":"6","key":"2021121019560196700_B1","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1097\/01.inf.0000070842.44115.f5","article-title":"Preventing mother-to-child transmission of human immunodeficiency virus type 1 in resource-poor countries.","volume":"22","author":"Shetty","year":"2003","journal-title":"Pediatr Infect Dis J"},{"issue":"2","key":"2021121019560196700_B2","doi-asserted-by":"crossref","first-page":"020405","DOI":"10.7189\/jogh.06.020405","article-title":"Population-level effectiveness of PMTCT Option A on early mother-to-child (MTCT) transmission of HIV in South Africa: implications for eliminating MTCT.","volume":"6","author":"Goga","year":"2016","journal-title":"J Glob Health"},{"issue":"6","key":"2021121019560196700_B3","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1097\/INF.0000000000001840","article-title":"Introduction of routine HIV birth testing in the South African National Consolidated Guidelines.","volume":"37","author":"Moyo","year":"2018","journal-title":"Pediatr Infect Dis J"},{"issue":"11","key":"2021121019560196700_B4","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1097\/00002030-199711000-00012","article-title":"Does umbilical cord blood polymerase chain reaction positivity indicate in utero (pre-labor) HIV infection?","volume":"11","author":"Biggar","year":"1997","journal-title":"AIDS"},{"issue":"21","key":"2021121019560196700_B5","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1056\/NEJMoa0800971","article-title":"Early antiretroviral therapy and mortality among HIV-infected infants.","volume":"359","author":"Violari","year":"2008","journal-title":"N Engl J Med"},{"key":"2021121019560196700_B6","doi-asserted-by":"crossref","first-page":"S51","DOI":"10.1097\/QAI.0000000000001319","article-title":"Scale-up of early infant HIV diagnosis and improving access to pediatric HIV care in global plan countries: past and future perspectives.","volume":"75","author":"Essajee","year":"2017","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"7","key":"2021121019560196700_B7","doi-asserted-by":"crossref","first-page":"2373","DOI":"10.1128\/JCM.00431-12","article-title":"Early diagnosis of in utero and intrapartum HIV infection in infants prior to 6 weeks of age.","volume":"50","author":"Lilian","year":"2012","journal-title":"J Clin Microbiol"},{"issue":"2","key":"2021121019560196700_B8","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/00002030-200401230-00017","article-title":"Timing of mother-to-child transmission of HIV-1 and infant mortality in the first 6 months of life in Harare, Zimbabwe.","volume":"18","author":"Zijenah","year":"2004","journal-title":"AIDS"},{"key":"2021121019560196700_B9","unstructured":"Department of Health\n . The South African antiretroviral treatment guidelines 2013: PMTCT guidelines. 2013. Available at: www.kznhealth.gov.za\/medicine\/2013_art_guidelines.pdf. Accessed October 20, 2018"},{"key":"2021121019560196700_B10","unstructured":"National Department of Health\n . National Consolidated Guidelines for the Prevention of Mother-to-Child Transmission of HIV (PMTCT) and the Management of HIV in Children, Adolescents and Adults. Pretoria, South Africa: National Department of Health; 2015. Available at: www.kznhealth.gov.za\/family\/HIV-Guidelines-Jan2015.pdf. Accessed October 23, 2018"},{"key":"2021121019560196700_B11","unstructured":"Department of Health\n . Guidelines for maternity care in South Africa. 4th ed. 2015. Available at: https:\/\/www.medbox.org\/guidelines-for-maternity-care-in-south-africa\/preview?q=guidelines-for-maternity-care-in-south-africa. Accessed October 13, 2018"},{"key":"2021121019560196700_B12","unstructured":"UNAIDS\n . 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva, Switzerland: UNAIDS. 2014. Available at: http:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/90-90-90_en.pdf. Accessed August 20, 2018"},{"issue":"8","key":"2021121019560196700_B13","doi-asserted-by":"crossref","first-page":"e1002375","DOI":"10.1371\/journal.pmed.1002375","article-title":"Pregnant and breastfeeding women: a priority population for HIV viral load monitoring.","volume":"14","author":"Myer","year":"2017","journal-title":"PLoS Med"},{"key":"2021121019560196700_B14","unstructured":"World Health Organization\n . Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Geneva, Switzerland: WHO; 2016. Available at: www.who.int\/hiv\/pub\/arv\/arv-2016\/en\/. Accessed July 20, 2018"},{"key":"2021121019560196700_B15","volume-title":"Evaluation of the Effectiveness of the National Prevention of Mother-To-Child Transmission (PMTCT) Programme Measured at Six Weeks Postpartum in South Africa, 2010","author":"Goga","year":"2012"},{"key":"2021121019560196700_B16","unstructured":"World Health Organization\n . Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis. 2017. Available at: https:\/\/www.who.int\/reproductivehealth\/publications\/rtis\/9789241505888\/en\/. Accessed October 23, 2018"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2018-3834\/1099638\/peds_20183834.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2018-3834\/1099638\/peds_20183834.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T06:10:01Z","timestamp":1639203001000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/143\/6\/e20183834\/37141\/An-Early-Infant-HIV-Risk-Score-for-Targeted-HIV"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,1]]},"references-count":16,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,6,1]]},"published-print":{"date-parts":[[2019,6,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2018-3834","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,1]]},"article-number":"e20183834"}}