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Late ELISA Testing in Infants Born to HIV-Positive Mothers
Mora V Puertolas1, Michael T Bolton2, Russell W Steele3
1University of Queensland School of Medicine and Ochsner Clinical School, New Orleans, LA, USA mora.puertolaslopez@uq.net.au.
Insights
A child born to an HIV-positive mother tested negative for HIV multiple times but was later diagnosed with infection. This case suggests reintroducing antibody testing for early detection in infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Virology
Background:
- Infants born to human immunodeficiency virus (HIV)-positive mothers are at risk of vertical transmission.
- Current guidelines recommend virologic testing for HIV in infants up to 18 months of age.
- Preventive measures include maternal antiretroviral therapy and infant prophylaxis.
Observation:
- A case study of an infant born to an HIV-positive mother, who initially tested negative for HIV via DNA polymerase chain reaction (PCR) at birth, 6 weeks, and 4 months.
- The infant received standard prophylactic zidovudine treatment.
- At 17 months, the infant exhibited declining health, and subsequent antibody and serology tests confirmed HIV infection.
Findings:
- Despite adherence to guidelines and negative early virologic tests, the infant developed HIV infection.
- Routine antibody testing at 18 months is not currently recommended for exposed infants with prior negative virologic results.
- This case highlights a potential gap in early HIV detection in high-risk infants.
Implications:
- Revisiting national guidelines to include 18-month antibody testing for HIV-exposed infants may improve early detection.
- Prompt diagnosis allows for timely initiation of antiretroviral therapy, improving long-term outcomes.
- Further research is needed to evaluate the efficacy and cost-effectiveness of reintroducing this testing protocol.
Abstract:
We present the case of a young boy who was born to a human immunodeficiency virus (HIV)-positive mother and originally found to be uninfected. Evidence-based guidelines were followed regarding the mother's prenatal and infant's postnatal care, including the avoidance of breast milk. HIV DNA polymerase chain reaction qualitative tests were obtained at birth, 6 weeks and 4 months, and were all negative. He also received 6 weeks of prophylactic zidovudine. Despite these measures, his health began to decline at 17 months of age and antibody and serology tests performed at this time confirmed HIV infection. Guidelines no longer recommend routine antibody testing at 18 months of age to confirm the absence of infection in exposed infants with a record of negative virology in the first year of life. Based on this case and others we propose that this test be added back to the national guidelines for the early detection and prompt treatment of HIV infection in infants born to HIV-positive mothers.
