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Diagnosis of HIV Infection

in Children

HAIVNHarvard Medical School AIDS

Initiatives in Vietnam

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Learning Objectives

By the end of this session, participants should be able to:Explain why early diagnosis of HIV in young children is importantApply the algorithm of HIV diagnosis by age groups in diagnosing HIV in infants and children

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Overview

In 2011, there were about 330 000 new HIV infection in children

Mother-to-child transmission accounts for the majority of HIV-infection in children <15 years

Diagnosis of HIV is challenging in infants in resource-limited countries

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Why is Early Diagnosis Crucial ?

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Early Diagnosis is Crucial (1)

Early diagnosis of HIV helps to:identify HIV infected children before they become symptomaticallow healthcare providers to make appropriate care and treatment:

• Register at HIV OPC• Assist on infant feeding• Provide OI prophylaxis• Prescribe ART

Early Diagnosis is Crucial (2)

35%

53%

0

10

20

30

40

50

60

0 month 12 months 24 months

Mortality rate in HIV-infected children

Newell ML et al. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: A pooled analysis. Lancet 2004; 364:1236-43.

18 months

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Early Diagnosis in Children < 18 Months Old

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Early HIV Diagnosis in Children <18 Months Old

Diagnosis of HIV in this age group:ELISA cannot be used as maternal antibodies are still present, rendering antibody-based testing for HIV unreliablePCR can detect viral DNA/RNA directly and is the test of choice (which can be done at 4-6 weeks of age)

Time Frame for PCR

264

0

20

40

60

80

100

120

0 week 9 months 12 months 18 months

%

% HIV Antibody

WHO Technical Publication No. 51: Management of HIV infection in infants and children: A clinical manual 2006.

Presence of HIV antibodies (from mother) in HIV-exposed but un-infected children

Early Diagnosis by PCR

6 weeks

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Early Diagnosis Using Dried Blood Spot (DBS)

DBS is prepared by putting drops of blood on a piece of paper and allowing them to dry

Can be stored and shipped to testing facilities at room air, over 3-7 days

PCR using DBS is as effective as PCR using liquid blood samples

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HIV Diagnosis in Infants < 9 Months Old

If positive:Initiate ARV treatmentDo 2nd PCR for confirmation as soon as possible Continue if breastfeeding

If negative:Wait until infant is 18 months old to perform ELISA for confirmationAdvise replacement feeding if possible

PCR with DBS at 4-6 weeks of age

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HIV Diagnosis in Infantsbetween 9-18 Months Old

If positive:• Follow PCR algorithm

If negative: • Infant is likely not HIV-infected

Perform HIV antibody test

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HIV Diagnosis in Infants< 18 Months Old and Suspected to Have HIV

If positive confirm diagnosis

with PCR(if PCR not available,

apply clinical criteria)

If negative child does not

have HIV

HIV-antibody test

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HIV diagnosis in infants < 18 months old

All children who have either:• first PCR negative • or second PCR negative

will be confirmed the HIV status by ELISA tests at the age of 18 months

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Case Studies

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Clinical Diagnosis for Severe HIV/AIDS in Children < 18 Months (1)

Apply clinical diagnostic criteria when virologic testing (PCR) is not available:

HIV antibody positive

1 clinical stage IV diagnosis

At least 2 out of 31. Oral candidiasis2. Severe bacterial pneumonia 3. Severe sepsis

oror

HIV antibody positive

+

+

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Clinical Diagnosis of Severe HIV/AIDS in Children < 18 Months (2)

Other factors assisting clinical diagnosis of severe HIV/AIDS disease:Child born to a mother who:

• has just died of HIV-related disease, or• has advanced HIV/AIDS disease

Child’s CD4 percentage < 20%

In these cases, definitive diagnosis with virological testing

should be done as soon as possible.

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HIV Diagnosis in Children > 18 Months

Definitive diagnosis of HIV infection in children >18 months of age is based on HIV antibody test

HIV infection is confirmed when the serum is positive with 3 tests using 3 different bioproducts

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Key Points

Early diagnosis allows healthcare providers to make appropriate care and treatment

In exposed children <18 months, HIV infection should be confirmed as early as possible using PCR

Clinical diagnosis of severe HIV/AIDS in infants should be considered if HIV is suspected

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Thank you!

Questions?