Infant human immunodeficiency virus diagnosis in resource-limited settings: issues, technologies, and country experiences.
Diagnosing human immunodeficiency virus (HIV) infection in infants is difficult because maternal HIV antibodies cross the placenta, causing positive serologic tests in HIV-exposed infants for the first several months of life. Early definitive diagnosis of HIV requires virologic testing such as polymerase chain reaction (PCR), which is the diagnostic standard in resource-rich settings but has been too complex and expensive for widespread use in most countries with high HIV prevalence. Early PCR testing can help HIV-infected infants access treatment, provide psychosocial benefits for families of uninfected infants, and help programs for prevention of mother-to-child transmission of HIV monitor their effectiveness. HIV testing, including PCR, is increasingly available for infants in resource-limited settings, but there are many barriers and complex policy decisions that need to be addressed before universal early testing can become standard. This paper reviews challenges and progress in the field and suggests ways to facilitate early infant testing in resource-limited settings.
Creek
Tracy L
TL
Centers for Disease Control and Prevention/National Center for HIV, Hepatitis, STD, TB Prevention/Global AIDS Program, Atlanta, GA 30333, USA. tcreek@cdc.gov
Sherman
Gayle G
GG
Nkengasong
John
J
Lu
Lydia
L
Finkbeiner
Thomas
T
Fowler
Mary Glenn
MG
Rivadeneira
Emilia
E
Shaffer
Nathan
N
D000349:Africa; D004279:DNA, Viral / Q000097:blood; D006678:HIV / Q000235:genetics / Q000276:immunology; D015483:HIV Antibodies / Q000097:blood; D016655:HIV Core Protein p24 / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis* / Q000821:virology; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010808:Physical Examination; D016133:Polymerase Chain Reaction; D017410:Practice Guidelines as Topic; D012367:RNA, Viral / Q000097:blood; D013997:Time Factors