HIV Diagnosis in Children

Definite rolling out of HIV in asymptomatic infant of HIV infected mother should be with considered with 2 negative PCR tests on infant, with one at least in 4 month old age or later. These tests are better to be done 2 weeks after cessation of prophylaxis to avoid becoming false negative. If virological tests are not available, definite roll out of HIV infection can be reached by doing 2 serological tests after 6 months old age (4th generation ELISA). One negative serology at age 6m is presumptive exclusion of HIV infection.We do not recommend breastfeeding in HIV infected mothers if safe appropriate substitute milk is available, but if the infant received breast milk, it is better to repeat test 6 weeks after cessation of breast feeding. Laboratory diagnosis of HIV in children depends on the age of child. In children lower than 18 months old age, virological tests like DNA PCR or RNA PCR will help, as mother antibodies pass the placenta and will make the test false positive in child. These virological tests can be done on plasma or dried blood spot at birth or at first hours thereafter. It should be mentioned that usage of anti-retroviral drugs (ARV) by mother or baby may affect the result of the tests.If the 1st test at first 48 hour is negative it should be repeated at 4-6 weeks and also 4 months age before definite role out HIV infection in asymptomatic infant of HIV positive mother baby. Till second test prophylaxis should be begin. If the result of 1st test is positive in infant, the second test should be done immediately and then ART treatment should be begin without delay, even before gaining the result of first test. It has to be emphasized that every first positive PCR ahould be accompanied with requesting second test and also starting 3 drugs ART without delay.