Research published in PLoS Medicine focused on the value of confirmatory testing for human immunodeficiency virus (HIV) in infants when using nucleic acid amplification tests (NAATs) due to false-positive rates of more than 10%.1
HIV infection in infants is still a major concern in low-income countries, and early detection is essential for exposed infants. Policy surveys show that 38% of high-burden countries do not include confirmatory testing in their guidelines, often due to high costs associated with the testing. Researchers therefore used a computer simulation model of HIV infection to investigate the clinical and economic outcomes of early infant diagnosis (EID) with and without confirmatory testing.
The Cost-Effectiveness of Preventing AIDS Complications (CEPAC)—Pediatric model was used to simulate cohorts of HIV-exposed infants in South Africa and follow them from birth to death. One cohort received 6-week EID testing without confirmatory testing and the other cohort underwent 6-week EID testing with confirmatory testing. Cohort input data were obtained from published trials on HIV transmission, disease progression, and antiretroviral treatment outcomes in sub-Saharan Africa, and NAAT specificity was modeled after a 2015 WHO meta-analysis.2
Lifetime cost of an HIV-exposed infant was US $1830 without confirmatory testing and US $1790 with testing. The use of confirmatory testing would be anticipated to save more than US $1,050,000 by averting unnecessary antiretroviral therapy and other HIV treatments. Even with many variations to the model parameters, confirmatory testing remained cost-effective.
The investigators concluded that confirmatory testing should be implemented in all cases using virologic assays for the cost-saving benefits alone; however, there is also likely to be positive health outcomes by avoiding medical toxicities and treatment-related complications in patients receiving false-positive results, although this scenario was not explicitly tested here.
- Dunning L, Francke JA, Mallampati D, et al. The value of confirmatory testing in early infant HIV diagnosis programmes in South Africa: a cost-effectiveness analysis. PLoS Med. 2017;14:e1002446.
- Mallampati D, Ford N, Hanaford A, Sugandhi N, Penazzato M. Performance of virological testing for early infant diagnosis: a systematic review. J Acquir Immune Defic Syndr. 2017;75(3):308-314.