How is HIV infection diagnosed in neonates?

Updated: Jun 23, 2020
  • Author: Philip A Chan, MD, MS; Chief Editor: John Bartlett, MD  more...
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Diagnosis in newborns

HIV antibody testing, including newer combination antigen/antibody immunoassays, are not helpful in diagnosing neonatal HIV infection, since transplacental transfer of antibodies during the third trimester of pregnancy causes positive results in infants born to HIV-infected mothers. Viral load assays (nucleic acid tests) can be used to diagnose HIV infection in infants. [15]

Initial testing should occur as soon as possible after birth, and, because transmission typically occurs at the time of delivery, repeated negative results are required to rule out infection. The schedule for virologic testing in infants exposed to perinatal HIV depends on transmission risk. Infants who are born to mothers who are engaged in medical care, received adequate prenatal services, and have undetectable viral loads are considered lower risk. Infants born to mothers who did not receive adequate prenatal care, had detectable HIV viral loads, or were diagnosed with HIV infection during pregnancy are considered high risk.

Definitive exclusion of HIV infection requires two or more negative viral load test results, one performed at age 1 month and a second at age 4 months, or two negative antibody test results obtained when the infant is aged 6 months or older. Note that maternal HIV antibodies can persist beyond age 12 months, so definitive proof may be delayed, even with negative DNA PCR results. Almost all infants will have lost their maternal antibodies by age 12-18 months. [15]

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