Reader’s Question on HIV Infection…

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 transmission:

* 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 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 infant.

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 of age.

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 questions?
* 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 likely clear.

By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com

For Domestic & International Adoption Medical Records Review