dr Dinesh Kaul
Consultant Pediatric Infectious Diseases

About Author

Unlike adult population it is difficult in a newborn to diagnose the infection based on serological assays like HIV ELISA and Western Blot tests. They are antibody based tests which detect HIV 1 & 2 specific IgG antibodies in the blood. In infected mother these antibodies cross the placental barrier and reflect in the newborn and children till 15 – 18 months of age, till they are cleared. Therefore, the diagnosis in newborns and infants is confirmed by detection of HIV-1 genome by various molecular techniques like HIV–DNA PCR and HIV–RNA PCR or HIV– QT– NASBA.

Detection of two positive PCRs, (HIV – DNA – PCR) on two different occasions i.e. 8 weeks apart is taken as confirmation of HIV infections in infants and children. However, presence of HIV – 1 and 2 antibodies beyond 18 months of age is also an indication of HIV infection. But these should be further confirmed by HIV – DNA–PCR test before starting the infants on antiretroviral therapy.

Editorial Addendum on 22.7.2018

When we say antiretoviral therapy(ART), we mean the regular ART regime, which has to be started only after an infant is tested positive. However, the Nevirapine (NVP) prophylaxis has to be started for every infant at birth and has to be continued for 6 weeks. At 6 weeks, a DNA PCR testing is done, if positive then ART is initiated. If Negative, NVP is stopped and Cotrimoxazole Prophylaxis Therapy (CPT) is started and is continued further till 18 months of age.

Infant is again tested at 6 months, 12 months(optional) and then at 18 months age. At any stage if found positive for HIV, CPT is discontinued and regular ART is initiated. If infant tests negative for HIV even at 18 months of age, CPT is also discontinued.

Posted On: 16/07/2018

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