Diagnosis of HIV Infection Among HIV Rapid-Test–Negative Persons in a Hyperendemic Resource-Poor Region

Standard HIV antibody testing of high-risk persons often fails to detect recent infection. In this study conducted in a high-incidence region of South Africa, residual blood samples with seronegative HIV rapid test results were pooled and subjected to HIV nucleic acid amplification (NAAT). Nucleic acid testing was performed on individual samples in positive pools. NAAT-positive individuals were recalled for repeat rapid HIV antibody testing and appropriate clinical management.

Of 6910 individuals (median age, 27, 87% female, 88% of whom were pregnant), 55 had positive NAAT samples (positive rate, 0.8%). Of these, 3 (0.04%) had acute infection (present in the interval from virus acquisition until appearance of HIV antibodies), and 19 (0.3%) h…