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Diagnosis of HIV Infection in Children and Adolescents

  • Gayle ShermanEmail author
  • Ahmad Haeri Mazanderani
Chapter
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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.

Keywords

Early infant diagnosis Human immunodeficiency virus Polymerase chain reaction Viral load 

References

  1. 1.
    World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: WHO; 2016. http://www.who.int/hiv/pub/arv/arv-2016/en/. Accessed 21 Feb 2017.Google Scholar
  2. 2.
    World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva: WHO; 2016. http://www.who.int/maternal_child_adolescent/documents/hiv-infant-feeding-2016/en/. Accessed 27 Sept 2018.Google Scholar
  3. 3.
    Goga A, Jackson D, Lombard C, et al. Highest risk of mother to child transmission of HIV or death in the first 6 months postpartum: results from 18 month follow-up of an HIV-exposed national cohort, South Africa. In: Paper presented at 21st AIDS conference, Durban, 18–22 July 2016; 2016.Google Scholar
  4. 4.
    World Health Organization. Global guidance on criteria and processes for validation: elimination of mother-to-child transmission (EMTCT) of HIV and syphilis. Geneva: WHO; 2014. http://apps.who.int/iris/bitstream/10665/112858/1/9789241505888_eng.pdf?ua=1&ua=1. Accessed 21 Feb 2016.Google Scholar
  5. 5.
    Joint United Nations Programme on HIV/AIDS. UNAIDS Data. Geneva: UNAIDS; 2018. http://www.unaids.org/en/resources/documents/2018/unaids-data-2018. Accessed 26 Feb 2019.Google Scholar
  6. 6.
    Haeri Mazanderani A, Moyo F, Kufa T, et al. Declining baseline Viremia and escalating discordant HIV-1 confirmatory results within South Africa’s early infant diagnosis program, 2010–2016. J Acquir Immune Defic Syndr. 2018;77(2):212–6.CrossRefGoogle Scholar
  7. 7.
    Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV. Guidelines for the use of antiretroviral agents in pediatric HIV infection. http://aidsinfo.nih.gov/contentfiles/lvguidelines/pediatricguidelines.pdf. Accessed 9 Mar 2019.
  8. 8.
    World Health Organization. HIV diagnosis and ARV use in HIV-exposed infants: a programmatic update. Geneva: WHO; 2018. http://www.who.int/iris/handle/10665/273155. Accessed 2 Oct 2018.Google Scholar
  9. 9.
    Sherman GG. HIV testing during the neonatal period. S Afr J HIV Med. 2015;16(1):362.  https://doi.org/10.4102/_sajhivmed.v16il.362.CrossRefGoogle Scholar
  10. 10.
    South African National Department of Health. Guideline for the Prevention of Mother to Child Transmission of Communicable Infections (HIV, Hepatitis, Listeriosis, Malaria, Syphilis and TB) 2019. http://www.bit.ly/2019-PMTCT-Guidelines. Accessed 29 Nov 2019.

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Paediatrics and Child Health, Faculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
  2. 2.Centre for HIV and STIs, National Institute for Communicable Diseases, a division of the National Health Laboratory ServiceJohannesburgSouth Africa
  3. 3.Department of Medical Virology, Faculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa

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