Chapter

Human Immunodeficiency Virus type 1 (HIV-1) and Breastfeeding

Volume 743 of the series Advances in Experimental Medicine and Biology pp 51-65

Date:

Early Diagnosis of HIV Infection in the Breastfed Infant

  • Chin-Yih OuAffiliated withDivision of Global HIV/AIDS (DGHA), Center for Global Health, Centers for Disease Control and Prevention (CDC)CDC Global AIDS ProgramUCLA School of Public Health Email author 
  • , Susan FiscusAffiliated withDepartment of Microbiology and Immunology, University of North Carolina
  • , Dennis EllenbergerAffiliated withGlobal AIDS Program, U.S. Centers for Disease Control and Prevention
  • , Bharat ParekhAffiliated withGlobal AIDS Program, U.S. Centers for Disease Control and Prevention
  • , Christine KorhonenAffiliated withDivision of Global HIV/AIDS (DGHA), Center for Global Health, Centers for Disease Control and Prevention (CDC)CDC Global AIDS ProgramUCLA School of Public Health
  • , John NkengasongAffiliated withGlobal AIDS Program, U.S. Centers for Disease Control and Prevention
  • , Marc BulterysAffiliated withDivision of Global HIV/AIDS (DGHA), Center for Global Health, Centers for Disease Control and Prevention (CDC)CDC Global AIDS ProgramUCLA School of Public Health

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Abstract

More than 90% of the 370,000 pediatric human immunodeficiency virus type 1 (HIV-1) infections globally in 2009 were acquired through mother-to-child transmission (MTCT) [1], and most of these transmissions occurred in sub-Saharan Africa. MTCT of HIV-1 occurs either during late pregnancy, the intrapartum period, or breastfeeding [2, 3]. With the application of prophylactic antiretroviral (ARV) therapy and breastfeeding avoidance, MTCT is now observed in only 1–2% of at-risk infants in developed countries [4, 5]. The majority of pregnant women residing in high HIV-burden, resource-limited countries (RLCs) are still not aware of their infection status and do not receive timely intervention measures to prevent vertical transmission [6–11]. Untreated infected infants have high HIV-related morbidity and mortality. Approximately 33% of the untreated infected infants in RLCs die during their first year of life, and >50% die within their first 2 years [12]. Treating infants early greatly reduces mortality and morbidity [13]. Recognition of the importance of reducing infant HIV mortality has facilitated the development of methods to bring appropriate testing closer to pregnant and lactating mothers, to identify HIV-infected infants earlier, and to provide timely access to life-saving ARV treatment and care. New and accurate diagnostic methods have emerged in the last few years, and many of these methods have been field-validated. This diagnostic service should not comprise a stand-alone program but must be integrated into the overall mother and child health programs to achieve the goal of prevention of mother-to-child transmission (PMTCT) [14, 15]. In this chapter, we review currently available diagnostic methodologies, including their advantages and disadvantages, their testing algorithms, and their quality assurance requirements, with a particular focus on early HIV diagnosis in the breastfed infant. Further, we discuss efforts toward the development of simple, accurate, and rapid diagnostic applications.