What are the recommendations for diagnosing pediatric HIV infection in infants?

Updated: Mar 05, 2020
  • Author: Delia M Rivera, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

The 2010 Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children [3] recommendations for diagnosing infants are as follows:

  • Because of the persistence of the maternal HIV antibody, infants younger than 18 months require virologic assays that directly detect HIV in order to diagnose HIV infection

  • Preferred virologic assays include HIV bDNA PCR and HIV RNA assays

  • Further virologic testing in infants with known perinatal HIV exposure is recommended at 14 days, at 1 month, and at 4 months.

  • An antibody test to document seroreversion to HIV antibody–negative status in uninfected infants is no longer recommended at age 12–18 months

  • In children 18 months and older, HIV antibody assays can be used for diagnosis

The Panel does not recommend use of the currently approved HIV p24 antigen assay for infant diagnosis in the United States because the sensitivity and specificity of the assay in the first months of life is less than that of other HIV virologic tests.

Within the first 48 hours, 14 days, and 4 weeks of life, 38%, 93%, and 96% of infected children, respectively, have positive HIV DNA PCR results. Any positive HIV DNA PCR finding should be confirmed with follow-up HIV DNA PCR before infection is diagnosed.


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