At present, the majority of infants are diagnosed on the basis of symptomatic HIV disease and the positive HIV antibody test of the mother of the child. The child of an HIV infected mother can acquire HIV antibodies from his/her mother during pregnancy and via breast milk if breastfed. These may persist in his or her blood until 15-18 months of age, even if the child is not infected with HIV. Thus a child may test HIV positive by an antibody test (e.g. rapid test or ELISA) without actually being infected.
HIV antibody tests (e.g. rapid and ELISA) should not be performed on young infants given the fact that these may measure maternal antibody. Care should be taken not to mislabel a child by assigning an HIV positive status if the mother is HIV positive. The correct term to use for a child is HIV exposed. No child under 18 months of age should be labelled HIV-positive based on HIV rapid test or ELISA antibody detection methods.
HIV infection can be diagnosed in most infected infants by the age 6 weeks by using the DNA PCR technique where available
Figure 2: HIV Testing by PCR for Children below 18 months of age
Note: A second specimen is necessary for PCR to confirm an initial positive result.
If PCR is unavailable: continue cotrimoxazole and regular monthly clinical monitoring.
For all children determined to be HIV negative but are still being breastfed by HIV+ mothers, appropriate counselling should be given to the mother on the risks and potential for HIV transmission to the child.