Infant human immunodeficiency virus diagnosis in resource-limited settings: Issues, technologies, and country experiences

University of the Witwatersrand, Johannesburg, Gauteng, South Africa
American journal of obstetrics and gynecology (Impact Factor: 4.7). 10/2007; 197(3 Suppl):S64-71. DOI: 10.1016/j.ajog.2007.03.002
Source: PubMed


Diagnosing human immunodeficiency virus (HIV) infection in infants is difficult because maternal HIV antibodies cross the placenta, causing positive serologic tests in HIV-exposed infants for the first several months of life. Early definitive diagnosis of HIV requires virologic testing such as polymerase chain reaction (PCR), which is the diagnostic standard in resource-rich settings but has been too complex and expensive for widespread use in most countries with high HIV prevalence. Early PCR testing can help HIV-infected infants access treatment, provide psychosocial benefits for families of uninfected infants, and help programs for prevention of mother-to-child transmission of HIV monitor their effectiveness. HIV testing, including PCR, is increasingly available for infants in resource-limited settings, but there are many barriers and complex policy decisions that need to be addressed before universal early testing can become standard. This paper reviews challenges and progress in the field and suggests ways to facilitate early infant testing in resource-limited settings.

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Available from: Gayle Sherman
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    • "Second, we need to diagnose infants born to HIV-infected mothers, particularly in sub-Saharan Africa. Due to the placental transfer of antibodies during pregnancy, infants may test positive on serological assays yet may not be infected with HIV [145]. Currently, infant diagnosis is primarily performed by collecting dried blood spots and transporting the samples to central testing laboratories for DNA testing [146]. "
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    • "The reason for higher rates most likely a high prevalence of HIV infection among pregnant women in Mbeya (10.4%) compared to that of Kilimanjaro and Tanga, which ranged from 1 to 3%. The infection rate among HIV exposed infants may decrease with better resourced PMTCT programs and provision of more efficacious regimens [17]. "
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    • "Globally, only 15% of HIV-exposed infants access early infant diagnosis [11]. Studies showed that about 20% of HIV-positive infants die before six months and 35% to 40% die before 12 months [11,12]. Early infant diagnosis is a crucial step to facilitate access to ART, to improve infants' survival and to evaluate the effectiveness of PMTCT programmes [11-13]. "
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