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Updated May 15, 2012

Early Infant Diagnosis of HIV

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A 22-year-old Angolan woman presents with her 5-week-old newborn infant to the Maternal-Child health center for their first visit since delivery. She lives in a rural outlying village and has traveled 2 hours to reach the clinic in the provincial capital. She was diagnosed with HIV during her second trimester of pregnancy with two positive rapid HIV tests. A CD4 count drawn upon HIV diagnosis was 215 cells/mm3. Routine viral load testing is not available in this setting. She returned for one additional prenatal visit during her third trimester and was placed on an antiretroviral regimen of zidovudine, lamivudine, and nevirapine, which she states she has taken reliably ever since. She gave birth to a healthy-appearing male infant via normal spontaneous vaginal delivery in her home with the help of a traditional birth attendant. The delivery was uncomplicated and she has been breastfeeding the infant regularly without problems. No infant prophylaxis has been given.

According to the 2010 WHO Antiretroviral Therapy for HIV Infection in Infants and Children guidelines, what is the most appropriate next step regarding HIV testing in the infant?

A Perform a rapid HIV 1/2 antibody test (e.g. Determine or Unigold) on the baby at 4 to 6 weeks of age.
B Perform a DNA or RNA PCR test on a dried bloodspot sample only after the infant has stopped breastfeeding. If the initial test is POSITIVE, have the infant return in 2 months for a repeat confirmatory sample.
C Perform a DNA or RNA PCR test on a dried bloodspot sample at 4 to 6 weeks of age. If the initial test is POSITIVE, start the infant on anti-retroviral therapy immediately and collect a second blood sample for confirmatory HIV testing.
D Perform a DNA or RNA PCR test on a dried bloodspot sample at 4-6 weeks of age. If the initial test is POSITIVE, have the infant return in 2 months for confirmatory HIV testing.