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Early Infant Diagnosis: A New Tool of HIV Diagnosis in Children
Kamlesh Kumar Jain1, Raj Kumar Mahajan, Manoj Shevkani
1Basic Service Division, Gujarat State AIDS Control Society, Ahmedabad, India.
Insights
Early infant diagnosis (EID) using DNA polymerase chain reaction (DNAPCR) is crucial for infants under 18 months. Dried blood spot (DBS) testing is accurate and cost-effective for diagnosing HIV in infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Standard HIV antibody tests are ineffective for infants under 18 months.
- Early diagnosis of HIV in infants is critical to prevent mortality.
- The Early Infant Diagnosis (EID) project utilizes DNA polymerase chain reaction (DNAPCR) for diagnosis.
Purpose of the Study:
- To evaluate factors influencing mother-to-child HIV transmission.
- To assess the effectiveness of different diagnostic methods for early infant diagnosis (EID).
- To analyze the impact of interventions like ARV prophylaxis and feeding methods on HIV transmission.
Main Methods:
- Analysis of data from 326 infants (< 18 months) born to HIV-positive mothers or with suspected HIV.
- Data collected on infant age, feeding type, ARV prophylaxis, and delivery method.
- Comparison of HIV diagnosis using Dried Blood Spot (DBS) and Whole Blood Sample (WBS) methods.
Main Results:
- Lower HIV transmission rates observed in infants receiving ARV prophylaxis compared to those not receiving it.
- HIV transmission was higher in normal deliveries than cesarean deliveries.
- Replacement feeding showed lower transmission rates than breast/mixed feeding.
Conclusions:
- Dried Blood Spot (DBS) testing is a reliable, cost-effective, and less cumbersome alternative to Whole Blood Sample (WBS) for early infant diagnosis (EID).
- Nevirapine administration at birth to mother-baby pairs reduced mother-to-child HIV transmission (MTCT) by 36%.
Background:
Standard assay has limited utility in diagnosing HIV reactivity among infants till the age of 18 months by which time, many HIV-infected infants expire. The test for diagnosing infant and children below 18 months is DNA polymerase chain reaction (DNAPCR) either by dried blood spot (DBS) or whole blood sample (WBS). Early infant diagnosis (EID) project is implemented in 18 districts of Gujarat through 33 PPTCT centers from 1st April 2010. Present analysis is done to evaluate factors curbing mother to child HIV transmission.
Materials And Methods:
Study included all children (< 18 months) who are born to HIV-positive mothers or referred children with signs/ symptoms of HIV with unknown parent status or children already on anti-retroviral therapy whose status could not be confirmed by antibody tests. Data was compiled and analyzed according to the infant's age at testing, type of feeding, history of Anti retero viral (ARV) prophylaxis, and type of delivery. Data compiled between April and August 2010 was used for the analysis.
Results:
Cohort of 326 infants was followed up, fewer infants (14/270) who received ARV prophylaxis tested positive than those who did not (23/56). Transmission was more in normal delivery (29/252) than cesarean (8/74). Low transmission rate was seen in replacement feeding (13/208) than breast/mixed feeding (24/94). Out of 37 samples found positive by the DBS, 17 were sent for WBS and all were found to be positive.
Conclusion:
DBS test results were found as accurate as WBS. So DBS (less cumbersome and cost effective) can be used in future exclusively. Nevirapine administration at birth as mother baby pair showed 36% decrease in MTCT.
