A human immunodeficiency virus screening algorithm to address the high rate of false-positive results in pregnant women in Japan

Takako Shima-Sano, Rika Yamada, Kazuyo Sekita, Raleigh W. Hankins, Hiromasa Hori, Hiroshi Seto, Koji Sudo, Makiko Kondo, Kazuo Kawahara, Yuki Tsukahara, Noriyuki Inaba, Shingo Kato, Mitsunobu Imai

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Prenatal human immunodeficiency virus (HIV) testing is essential for the prevention of mother-to-child transmission. However, false-positive results of screening testing are a concern as they may cause unnecessary emotional stress to pregnant women waiting for confirmatory test results. In regions with an extremely low prevalence, the positive predictive values of screening are unacceptably low rate. Here, we propose a HIV screening algorithm consisting of serial two fourth-generation enzyme immunoassays to reduce the number of false-positive screening results. Methodology/Principal Findings:When 6461 pregnant women presenting to two maternity hospitals located in the Tokyo metropolitan area of Japan from September, 2004 to January, 2006 were tested using Enzygnost HIV Integral as a first screening test, 27 showed positive reactions. When these positive reaction samples were tested using VIDAS HIV DUO Quick as a second screening test, only one of them had a positive reaction, and the remaining 26 were nonreactive. Confirmatory Western blots and nucleic acid amplification test also showed that one was positive and the remaining 26 were negative; the subject who was positive with the confirmatory tests was identical to the subject who was positive with the second screening test. Thus, by adding the second screening test, the false-positive rate was improved from 0.4% to 0%, and the positive predictive value from 3.7% to 100%, compared with the single screening test. Conclusion: By applying our serial screening algorithm to HIV testing in maternity hospitals, many uninfected pregnant women would not need to receive confirmatory tests and be subjected to emotional turmoil while waiting for their confirmatory test results. This algorithm would be suitable for HIV testing of pregnant women living in low prevalence regions such as Japan.

Original languageEnglish
Article numbere9382
JournalPLoS One
Volume5
Issue number2
DOIs
Publication statusPublished - 2010 Feb 23

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Human immunodeficiency virus
pregnant women
Viruses
Pregnant Women
Japan
Screening
HIV
screening
Maternity Hospitals
testing
Nucleic Acid Amplification Techniques
Testing
Tokyo
Immunoenzyme Techniques
Psychological Stress
Western Blotting
Mothers
enzyme immunoassays
Nucleic Acids
nucleic acids

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

A human immunodeficiency virus screening algorithm to address the high rate of false-positive results in pregnant women in Japan. / Shima-Sano, Takako; Yamada, Rika; Sekita, Kazuyo; Hankins, Raleigh W.; Hori, Hiromasa; Seto, Hiroshi; Sudo, Koji; Kondo, Makiko; Kawahara, Kazuo; Tsukahara, Yuki; Inaba, Noriyuki; Kato, Shingo; Imai, Mitsunobu.

In: PLoS One, Vol. 5, No. 2, e9382, 23.02.2010.

Research output: Contribution to journalArticle

Shima-Sano, T, Yamada, R, Sekita, K, Hankins, RW, Hori, H, Seto, H, Sudo, K, Kondo, M, Kawahara, K, Tsukahara, Y, Inaba, N, Kato, S & Imai, M 2010, 'A human immunodeficiency virus screening algorithm to address the high rate of false-positive results in pregnant women in Japan', PLoS One, vol. 5, no. 2, e9382. https://doi.org/10.1371/journal.pone.0009382
Shima-Sano, Takako ; Yamada, Rika ; Sekita, Kazuyo ; Hankins, Raleigh W. ; Hori, Hiromasa ; Seto, Hiroshi ; Sudo, Koji ; Kondo, Makiko ; Kawahara, Kazuo ; Tsukahara, Yuki ; Inaba, Noriyuki ; Kato, Shingo ; Imai, Mitsunobu. / A human immunodeficiency virus screening algorithm to address the high rate of false-positive results in pregnant women in Japan. In: PLoS One. 2010 ; Vol. 5, No. 2.
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abstract = "Background: Prenatal human immunodeficiency virus (HIV) testing is essential for the prevention of mother-to-child transmission. However, false-positive results of screening testing are a concern as they may cause unnecessary emotional stress to pregnant women waiting for confirmatory test results. In regions with an extremely low prevalence, the positive predictive values of screening are unacceptably low rate. Here, we propose a HIV screening algorithm consisting of serial two fourth-generation enzyme immunoassays to reduce the number of false-positive screening results. Methodology/Principal Findings:When 6461 pregnant women presenting to two maternity hospitals located in the Tokyo metropolitan area of Japan from September, 2004 to January, 2006 were tested using Enzygnost HIV Integral as a first screening test, 27 showed positive reactions. When these positive reaction samples were tested using VIDAS HIV DUO Quick as a second screening test, only one of them had a positive reaction, and the remaining 26 were nonreactive. Confirmatory Western blots and nucleic acid amplification test also showed that one was positive and the remaining 26 were negative; the subject who was positive with the confirmatory tests was identical to the subject who was positive with the second screening test. Thus, by adding the second screening test, the false-positive rate was improved from 0.4{\%} to 0{\%}, and the positive predictive value from 3.7{\%} to 100{\%}, compared with the single screening test. Conclusion: By applying our serial screening algorithm to HIV testing in maternity hospitals, many uninfected pregnant women would not need to receive confirmatory tests and be subjected to emotional turmoil while waiting for their confirmatory test results. This algorithm would be suitable for HIV testing of pregnant women living in low prevalence regions such as Japan.",
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