Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Management of Infants Born to Women with HIV Infection

Diagnosis of HIV Infection in Infants and Children

Last Updated: December 7, 2018; Last Reviewed: December 7, 2018

Panel’s Recommendations Regarding Diagnosis of HIV Infection in Infants and Children
Panel's Recommendations
  • Virologic assays (i.e., HIV RNA and HIV DNA nucleic acid tests [NATs]) that directly detect HIV must be used to diagnose HIV in infants and children aged <18 months with perinatal and postnatal HIV exposure; HIV antibody tests should not be used (AII).
  • HIV RNA or HIV DNA NATs are generally equally recommended (AII).
  • An assay that detects HIV non-B subtype viruses or Group O infections (e.g., an HIV RNA NAT or a dual-target total DNA/RNA test) is recommended for use in infants and children who were born to mothers with known or suspected non-B subtype virus or Group O infections (AII).
  • Virologic diagnostic testing is recommended for all infants with perinatal HIV exposure at the following ages:
    • 14 to 21 days (AII)
    • 1 to 2 months (AII)
    • 4 to 6 months (AII)
  • For infants at higher risk of perinatal HIV transmission, additional virologic diagnostic testing is recommended at birth (AII) and at 2 to 4 weeks after cessation of antiretroviral prophylaxis (BII).
  • A positive virologic test should be confirmed as soon as possible by a repeat virologic test on a second specimen (AII).
  • Definitive exclusion of HIV infection in nonbreastfed infants is based on two or more negative virologic tests, with one obtained at age ≥1 month and one at age ≥4 months, or two negative HIV antibody tests from separate specimens obtained at age ≥6 months (AII).
  • Some experts confirm the absence of HIV at 12 to 18 months of age in children with prior negative virologic tests by performing an HIV antibody test to document loss of maternal HIV antibodies (BIII).
  • Since children aged 18 to 24 months with perinatal HIV exposure occasionally have residual maternal HIV antibodies, definitive exclusion or confirmation of HIV infection in children in this age group who are HIV antibody -positive should be based on an HIV NAT (AII).
  • Diagnostic testing in children with nonperinatal exposure only or children with perinatal exposure aged >24 months relies primarily on the use of HIV antibody (or antigen/antibody) tests; when acute HIV infection is suspected, additional testing with an HIV NAT may be necessary to diagnose HIV (AII).

Note: The National Clinician Consultation Center provides consultations on issues related to the management of perinatal HIV infection (1-888-448-8765; 24 hours a day, 7 days a week).

Rating of Recommendations: A = Strong; B = Moderate; C = Optional

Rating of Evidence: I = One or more randomized trials in children† with clinical outcomes and/or validated endpoints; I* = One or more randomized trials in adults with clinical outcomes and/or validated laboratory endpoints with accompanying data in children† from one or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; II = One or more well-designed, nonrandomized trials or observational cohort studies in children† with long-term outcomes; II* = One or more well-designed, nonrandomized trials or observational studies in adults with long-term clinical outcomes with accompanying data in children† from one or more similar nonrandomized trials or cohort studies with clinical outcome data; III = Expert opinion

† Studies that include children or children/adolescents, but not studies limited to post-pubertal adolescents

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