1 diagnosis of hiv infection in children haivn harvard medical school aids initiatives in vietnam
TRANSCRIPT
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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
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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)
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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?