How to Handle Potentially False-Positive HIV Test Results During Pregnancy

Pregnant women frequently undergo successive rapid-result HIV testing to determine status, but there currently aren’t any clear guidelines for how providers should handle discrepant—1 positive and 1 negative—results.

Moreover, making the wrong decisions about pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) treatment in pregnancy can have negative psychosocial, interpersonal, and health systems impacts.

Investigators in Africa seeking to identify the challenges of potentially false-positive HIV tests in pregnant women in the era of PrEP presented their data at the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019).

For a cluster randomized trial of women in Kenyan public health programs, the practice was to offer PrEP to HIV seronegative women during antenatal care and to conduct repeat HIV testing at each monthly follow-up visit during pregnancy and tri-monthly for postpartum women. If a first rapid-result test (Determine) was reactive, a second (First Response) was conducted. If the second test came back negative, both tests were repeated by a separate provider with DNA polymerase chain reaction (PCR).

As part of the trial, a total of 3135 repeat HIV tests were performed among 2231 women during pregnancy or in the postpartum care period. DNA PCR samples were collected from 5 individuals who returned discrepant results in 7 tests (0.22%, 95% CI: 0.09-0.46%). Of the 5 initial cases, all of the women exhibited negative DNA PCR and none initiated ART.

Investigators concluded that false-positive results occur at a low frequency with repeat rapid testing, and that discrepant results are more likely to be false positive than true positive. Women who are pregnant or on PrEP should begin ART immediately upon true positive results, investigators urge.

“Management of discrepant results needs to balance benefits of rapid ART for the prevention of mother-to-child transmission among true positives, with specific counseling about temporary ART and ‘disclosure’ among women with false-positive results,” the research team wrote in the abstract. “Expedited point-of-care HIV PCR could prevent unclear diagnosis, messaging, and treatment.”

The poster, “Challenges of Potentially False-Positive HIV Tests in Pregnant Women in the PrEP Era,” was presented on Wednesday, March 6, 2019, at CROI 2019 in Seattle, Washington.