Diagnosis of HIV infection in infants and children
Worldwide, in 2008, an estimated 430 000 [240 000–610 000] new infections due to the human immunodeficiency virus (HIV) occurred in children, of which 90% were acquired through motherto- child transmission (MTCT) of HIV. Of the 430 000 new infections, between 280 000 and 360 000 were acquired during labour and in the pre-partum period. Of the remaining new infections, the majority were acquired during breastfeeding.
In infants who acquire HIV around the time of delivery, disease progression occurs very rapidly in the first few months of life, often leading to death. To enable antiretroviral (ARV) prophylaxis to be given to infants as soon as possible after birth, all infants should have their HIV exposure status known at birth.
As not all mothers are given HIV tests, very few HIV-exposed infants are identified and very few infants are known to be gaining access to early diagnosis, the necessary prerequisite to ‘timely’ initiation of antiretroviral therapy (ART). Currently, only an estimated 15% of HIV-exposed infants needing testing are tested in the first two months of life.
Recently published data confirming dramatic survival benefits for infants started on ART as early as possible after the diagnosis of HIV, prompted a review of the World Health Organization (WHO) paediatric treatment guidelines. In June 2008, new guidance was issued, which recommends prompt initiation of ART in infants diagnosed with HIV infection.
In order to identify those infants who will need immediate ART, early confirmation of HIV infection is required. In November 2008, a meeting was convened to review recommendations by WHO for the diagnostic testing of HIV infection in infants and children. The meeting brought together the guideline review group that had developed the initial recommendations in 2005.
The guideline review group followed the grading of recommendations assessment, development and evaluation (GRADE) approach in reviewing the recommendations for early detection of HIV infection according to the current WHO Guidelines for Guidelines. This document contains the new recommendations. The full document, including GRADE evidence profiles and the factors that have been taken into account in the group's decision-making with respect to the strength of the recommendations, is available in the annexes above.