Related Experiment Video
Updated: Jun 19, 2025
Isolation of Leukocytes from Human Breast Milk for Use in an Antibody-dependent Cellular Phagocytosis Assay of HIV Targets
Published on: September 6, 2019
Late Identification of Perinatal Transmission of HIV in an Infant at High Risk
Thomas J O'Grady1, Suzanne Kaufman, Amanda Stolz
1AIDS Institute, New York State Department of Health, Albany, New York (Dr O'Grady, Ms Kaufman, Ms Stolz, Ms Haskin, Dr Gonzalez, and Dr Swain); Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, New York (Dr O'Grady); Wadsworth Center, New York State Department of Health, Albany, New York (Dr Styer, Ryman, Mr Sullivan, and Dr Parker); Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, New York (Dr Styer); and Division of Disease Control, Bureau of Hepatitis, HIV and STI, New York City Department of Health and Mental Hygiene, New York City, New York (Ms Suresh, Ms Shah, and Dr Torian).
Insights
Delayed diagnosis of perinatal HIV transmission in an infant highlighted the need for improved testing protocols. Updated guidelines now recommend earlier diagnostic specimen collection and follow-up testing for high-risk infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Perinatal HIV transmission remains a concern despite established prevention protocols.
- Social and structural factors can increase HIV transmission risk during pregnancy.
- Adherence to existing New York State Department of Health guidelines did not prevent a case of delayed diagnosis.
Purpose of the Study:
- To analyze a case of delayed perinatal HIV transmission diagnosis in an infant.
- To identify contributing social conditions and structural determinants to increased transmission risk.
- To inform revisions in HIV testing and treatment protocols for neonates.
Main Methods:
- Case study analysis of a perinatal HIV transmission.
- Review of diagnostic testing protocols and neonatal antiretroviral (ARV) guidelines.
- Evaluation of social determinants impacting transmission risk.
Main Results:
- A perinatal HIV transmission was diagnosed at 4 months of age despite adherence to current guidelines.
- The case highlighted potential deficiencies in the timing of HIV diagnostic testing and ARV initiation.
- This event spurred reevaluation of policies related to substance use during pregnancy and HIV testing.
Conclusions:
- Earlier diagnostic specimen collection at birth, before ARV initiation, is crucial for timely diagnosis.
- Post-ARV therapy virologic testing (2-6 weeks after discontinuation) is recommended for high-risk infants.
- Updated New York State guidelines now incorporate these recommendations to improve early detection and treatment of perinatal HIV.
Abstract:
The focus of this case study is the delayed diagnosis of a perinatal HIV transmission, which was identified when the infant reached 4 months of age, and the social conditions and structural determinants that contributed to the increased transmission risk. Despite adhering to the diagnostic testing protocols and neonatal antiretroviral (ARV) guidelines of the New York State Department of Health, this transmission still occurred. This transmission event prompted strategies to address criminalization of substance use during pregnancy and a reevaluation of the HIV testing and treatment protocols, including the timing of testing. Obtaining a diagnostic specimen at birth before initiating prophylactic or presumptive therapy, without causing delays in therapy, and incorporating HIV-1 DNA or RNA testing 2 to 6 weeks after discontinuing ARV therapy might have facilitated earlier detection and a quicker resumption of ARV therapy for this high-risk infant. Subsequently, the New York State HIV perinatal testing guidelines were updated. These changes included the recommendation to obtain a diagnostic specimen at birth before initiating ARV medications, whenever feasible, without causing delays in ARV initiation. Additionally, an extra virologic diagnostic test is recommended at 2 to 6 weeks after discontinuing ARVs for infants at high risk of perinatal HIV transmission, especially those with possible DNA or RNA suppression due to ARV prophylaxis or presumptive HIV therapy.
More Related Videos
07:36Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
05:51Intracerebroventricular and Intravascular Injection of Viral Particles and Fluorescent Microbeads into the Neonatal Brain
Published on: July 24, 2016
