From the Guidelines
Yes, a child can remain undiagnosed with Human Immunodeficiency Virus (HIV) until the age of 7, but this is unlikely if proper diagnostic testing is performed.
Diagnostic Challenges
- HIV infection can be diagnosed among children greater than or equal to 18 months of age by using standard HIV IgG antibody tests 1.
- However, because maternal IgG can be present in children less than 18 months of age, standard HIV-IgG serologic assays cannot be used to diagnose HIV infection in this age group 1.
- Advances in the development of viral detection assays, such as polymerase chain reaction (PCR), have made diagnosing HIV infection possible in nearly all infants by 4-6 months of age 1.
Diagnostic Recommendations
- Diagnostic testing should be performed before the infant is aged 48 hours, at age 1-2 months, and at age 3-6 months 1.
- Testing at age 14 days also may be advantageous for early detection of infection 1.
- Infection is definitively ruled out if the PCR is negative at >1 and >4 months of age and the infant is asymptomatic 1.
Importance of Early Diagnosis
- Early diagnosis of HIV infection is crucial for initiating antiretroviral therapy and preventing disease progression 1.
- The use of postexposure prophylaxis in the neonate, instituted as soon as possible after birth, can still significantly decrease HIV transmission 1.
From the Research
HIV Diagnosis in Children
- The diagnosis of Human Immunodeficiency Virus (HIV) in children can be challenging, especially in the early stages of infection 2.
- Infants born to HIV-infected mothers can acquire passively transferred antibodies to HIV, which can persist for up to 15 months, making diagnosis difficult in children under 15 months of age 2.
- In children over 15 months, HIV infection can be diagnosed using serologic testing, viral isolation, or viral antigen detection 2, 3.
Age of Diagnosis
- The median age at diagnosis of AIDS in children with perinatally acquired HIV infection is 12-24 months 3.
- However, some children may remain asymptomatic and undiagnosed until later in childhood, with one study finding that 23.8% of children with perinatally acquired HIV infection remained asymptomatic at a mean age of 136 months (approximately 11 years) 4.
- Another study found that some children may not develop HIV-related symptoms until after 48 months of age, and may remain undiagnosed until the age of 7 or older 4.
Factors Affecting Diagnosis
- The route of infection, with transplacental transmission being the most common route of infection in children 2.
- The mother's health status, with women who give birth to infected children often being asymptomatic 2.
- The availability of adequate pediatric HIV consultation services and informed primary care practitioners 5.