(1075) Higher Rates of False-Positive HIV Antigen/Antibody Screens During the COVID-19 Pandemic: Implications for Pregnant Patients

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: To compare the rates of false-positive HIV 4th generation screens among pregnant patients before and during the COVID-19 pandemic.

Study Design: A retrospective study evaluating the rates of false-positive HIV 4th generation screens among 44,187 pregnant patients was conducted. Pregnant patients from 3/2017-3/2019 were assigned to the “pre-COVID” cohort, and pregnant patients from 3/2020-3/2022 were assigned to the “COVID” cohort. Data including the date(s) and results of HIV 4th generation Ag/Ab combination tests and SARS-CoV-2 RT-PCR assays were ascertained via chart review. An HIV 4th generation test result was deemed “false-positive” if subsequent HIV-1/HIV-2 antibody differentiation immunoassays and/or HIV-1 nucleic acid tests were non-reactive.

Results: 42/22,073 (0.19%) patients with pre-COVID pregnancies who had HIV 4th generation tests were found to have abnormal results. In comparison, 71/22,114 (0.32%) patients with pregnancies during the pandemic had abnormal test results. 16/42 (38.1%) patients with abnormal results pre-COVID had false-positive HIV screens. In comparison, 48/71 (67.6%) COVID cohort patients with abnormal results had false-positive HIV screens. Overall, the rate of false-positive HIV 4th generation tests was significantly higher in the COVID cohort compared to the pre-COVID cohort (p=0.002). Among the 48 patients with false-positive HIV screens in the COVID cohort, 13 (27.1%) had a PCR-proven COVID-19 diagnosis during pregnancy preceding their false positive result. Interestingly, 9/13 patients (69.2%) also had at least one negative HIV 4th generation screening result predating their COVID-19 diagnosis.

Conclusion: Considering the maternal and neonatal implications of a positive HIV test result, OB/GYNs should be cognizant that false-positive results can occur in the setting of new/prior COVID-19 infections. Shared decision making should be used when considering the initiation of combination antiretroviral therapy, route of delivery and/or delay of breastfeeding for patients with a newly positive HIV 4th generation tests, particularly in the absence of other risk factors.

Primary & Presenting Author(s)

Madison E. Miller, MD (she/her/hers)
Henry Ford Health
Detroit, Michigan, United States

Coauthor(s)

RC
Rachel Cevigney, BS
Wayne State School of Medicine
Detroit, Michigan, United States
Mariam Ayyash, MD, MSCR
Henry Ford Health System
Detroit, Michigan, United States
MS
Majid Shaman, MD
Henry Ford Health System
W Bloomfield, Michigan, United States
MK
Monica Kole, MD
Henry Ford Health
Detroit, Michigan, United States