Diagnosis of HIV Infection in Children and Adolescents

Abstract

Early infant diagnosis (EID) facilitates timely linkage-to-care, initiation of antiretroviral therapy (ART), and subsequent virological suppression. Because of rapid disease progression, EID is essential for reducing the high morbidity and mortality rates associated with infant HIV infection. Mother-to-child transmission of HIV can occur in utero, intrapartum or postnatally, via breastfeeding. Hence, repeat testing at multiple intervals during infancy and childhood is recommended. Due to changing transmission patterns and findings that suggest antiretroviral drug exposure can reduce assay sensitivity, HIV diagnostic guidelines continue to evolve. The latest guidelines recommend routine HIV PCR testing among HIV-exposed infants <18-months of age at birth, 6 or 10-weeks of age, 6 or 9-months of age, 6-weeks post-cessation of breastfeeding, and at any time-point that a child presents with clinical signs in keeping with HIV infection. It is important for all infants who test positive or indeterminate to have confirmatory testing performed as soon after the initial screening test as possible, preferably at the time of ART initiation. Because of the transplacental transfer of maternal antibodies, HIV antibody tests are unable to diagnosis HIV infection among children <18-months of age. However, in older children and adolescents, HIV antibody tests are used to diagnose HIV in much the same way as in adults.