Early Diagnosis of HIV Infection in the Breastfed Infant

  • Chin-Yih Ou
  • Susan Fiscus
  • Dennis Ellenberger
  • Bharat Parekh
  • Christine Korhonen
  • John Nkengasong
  • Marc Bulterys
Chapter

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.

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Chin-Yih Ou
    • 1
    • 2
    • 3
  • Susan Fiscus
    • 4
  • Dennis Ellenberger
    • 5
  • Bharat Parekh
    • 5
  • Christine Korhonen
    • 1
    • 2
    • 3
  • John Nkengasong
    • 5
  • Marc Bulterys
    • 1
    • 2
    • 3
  1. 1.Division of Global HIV/AIDS (DGHA)Center for Global Health, Centers for Disease Control and Prevention (CDC)AtlantaUSA
  2. 2.CDC Global AIDS ProgramBeijingChina
  3. 3.UCLA School of Public HealthLos AngelesUSA
  4. 4.Department of Microbiology and ImmunologyUniversity of North CarolinaChapel HillUSA
  5. 5.Global AIDS ProgramU.S. Centers for Disease Control and PreventionAtlantaUSA

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