While there is no cure for AIDS yet, doctors are now able to
diagnose infants earlier, prevent mother-to-infant transmission and provide
life enhancing treatments for those affected.
Dynamics of Perinatal HIV transmission:
1) During pregnancy 2) During labor & Delivery (maternal
infant exchange of blood and other maternal secretions the actual delivery) 3)
After delivery through breast-feeding.
Several clinical factors increase the risk for perinatal HIV
* 1) Clinically advanced HIV disease in the mother
* 2) High plasma viral load in the maternal blood
* 3) Maternal IV drug use during the pregnancy
* 4) Preterm delivery
* 5) Breast feeding
The standard screening test for HIV infection is called the
ELISA. This test checks for the HIV antibody. A positive result does not
necessarily mean that the patient is ill. It needs to be confirmed with a more
specific test called a western blot test. This test is extremely important
because some persons can have a non-viral (other medical or immunologic
conditions) that can give a false positive ELISA test result. Rarely, (in less
than 1%) will an infected person fail to make antibody response to the HIV
virus but these patients are usually obviously very ill. A similar situation
may occur[gr1] in the very early weeks after the maternal primary infection
with the HIV virus. Almost always in both these types situations the more
sophisticated test like (western blot, viral cultures, PCR) is always positive.
Infants who are born to HIV-infected mothers will have
positive test results for the HIV antibody, regardless of infection status.
This is due to the maternal transplacental passage of maternal antibodies to
The average time to lose the maternal HIV antibody is about
10 months of age while all children lose the maternal HIV antibody by 18 months
A diagnosis for HIV can usually be made by 2 – 4 months of
age if the test performed are checking for HIV virus in the blood (nucleic acid
detection or HIV culture).
In an infant who was exposed to HIV mother, a negative test
result during the early period of life does not reliably rule out infection,
but if this infant is otherwise well, and has had at least two negative HIV
cultures or nucleic acid test performed over the age of one month and another
over the age of 3 months, this infant is unlikely to be infected.
These infants should be monitored for signs and symptoms of
the disease and should also be retested at 12 mo, 15 mo , 18mo and 24 mo. In
order to look for a reversion to a negative status and to confirm the absence
of the infection.
For the above referenced child we need to ask a few
* 1) Find out exactly what type of HIV testing was
performed, (ELISA, western blot. PCR or viral culture)
* 2) what was the child’s health status for the past 15
months? Did they have an overabundance of respiratory infections, ear
infections, thrush in the mouth?
* 3) Try to find out what is the biological mothers health
condition like now
If the appropriate test was indeed performed and this child
did not present with an unusual amount of infections, chances are good that
this child has not contracted the HIV disease. Obviously, as per the follow-up
protocol, we need to perform more HIV testing at 18 months of age and 24 months
of age. If the titers continue to remain negative, the patient is a more than
By George Rogu M.D.
Medical Director and Founder of Adoptiondoctors.com
The information and advice provided is intended to be
general information, NOT as advice on how to deal with a particular child's
situation and or problem. If your child has a specific problem you need to ask
your pediatrician about it - only after a careful history and physical exam can
medical diagnosis and/or treatment plan be made. This Web
site does not constitute a physician-patient relationship.