title: Infant human immunodeficiency virus diagnosis in resource-limited settings: issues, technologies, and country experiences.
abstract: 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.
authors.affiliation: Centers for Disease Control and Prevention/National Center for HIV, Hepatitis, STD, TB Prevention/Global AIDS Program, Atlanta, GA 30333, USA. tcreek@cdc.gov
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Creek
authors.forename: Gayle G
authors.initials: GG
authors.lastname: Sherman
authors.forename: John
authors.initials: J
authors.lastname: Nkengasong
authors.forename: Lydia
authors.initials: L
authors.lastname: Lu
authors.forename: Thomas
authors.initials: T
authors.lastname: Finkbeiner
authors.forename: Mary Glenn
authors.initials: MG
authors.lastname: Fowler
authors.forename: Emilia
authors.initials: E
authors.lastname: Rivadeneira
authors.forename: Nathan
authors.initials: N
authors.lastname: Shaffer
mesh_terms: 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