Early Infant Diagnosis (EID) of HIV: An Experience at a Tertiary Care Hospital in India


Introduction: Early infant diagnosis (EID) confers substantial benefit to HIV infected and HIV uninfected infants and to programmes providing prevention of mother to child transmission (MTCT), but has been challenging to implement in resource limited settings. Objectives: To find out the rate of perinatal transmission in infants born to HIV positive mothers, to study the effect of various predisposing factors on HIV transmission and to evaluate the utility of dried blood spot (DBS) specimen for EID of HIV. Methods: Infants born to HIV positive mothers were tested according to National AIDS Control Organization (NACO) guidelines. Infants of 6 weeks to 6 months of age (n = 84) were diagnosed by DBS PCR; DBS positive results were confirmed by whole blood PCR. Infants 6 - 18 months (n = 47) were subjected to antibody test and if positive were confirmed by DNA PCR. Detailed history including type of delivery, single dose nevirapine (SDN) and breast feeding was taken. Results: The HIV transmission rate was 10.69%. In children ≤ 6 months, who did not receive SDN the positivity was 44.44% (4/9) whereas in those who received SDN it was 6.66% (5/75), (P = 0.0063). In children > 6 months the positivity rate was significantly higher in breast fed 42.85% (3/7) as compared to non breast fed 5% (2/40) children (P = 0.0187). There was 100% concordance between DBS and whole blood PCR. Conclusions: In resource limited settings, though HAART should be considered to further reduce MTCT during pregnancy and to prevent the emergence of resistance, SDN should be kept as an option for mothers coming directly in labour. Also, extended ART should be provided to mothers who want to breast feed their children. Early infant diagnosis using DBS specimens will further reduce the morbidity and mortality in these children.

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S. M. Paranjpe, R. S. Phakade, N. A. Ingole and P. R. Mehta, "Early Infant Diagnosis (EID) of HIV: An Experience at a Tertiary Care Hospital in India," World Journal of AIDS, Vol. 2 No. 1, 2012, pp. 1-5. doi: 10.4236/wja.2012.21001.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] World Health Organization, “Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants-Recommendations for a Public Health Approach: 2010 Version,” WHO, Geneva, 2010 http://whqlibdoc.who.int/publications/2010/9789241599818_eng.pdf
[2] J. A. Volmink and B. J. Marais, “HIV: Mother-to-Child Transmission,” Clinical Evidence (Online), 2008, Published Online 5 February 2008. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907958/
[3] M. L. Newell, H. Coovadia, M. Cortina-Borja, N. Rollins, P. Gaillard and F. Dabis, “Ghent International AIDS Society (IAS) Working Group on HIV Infection in Women and Children. Mortality of Infected and Uninfected Infants Born to HIV-Infected Mothers in Africa: A Pooled Analysis,” Lancet, Vol. 364, No. 9441, 2004, pp. 1236-1243. doi:10.1016/S0140-6736(04)17140-7
[4] World Health Organisation, “WHO Recommendations on the Diagnosis of HIV in Infants and Children, 2010 Version,” WHO, Geneva, 2010. http://whqlibdoc.who.int/publications/2010/9789241599085_eng.pdf
[5] S. M. Jacob, D. Anitha, R. Vishwanath, S. Parameshwari and N. M. Samuel, “The Use of Dried Blood Spots on Filter Paper for the Diagnosis of HIV-1 in Infants Born to HIV Seropositive Women,” Journal of Medical Microbiology, Vol. 26, No. 1, 2008, pp. 71-74. doi:10.4103/0255-0857.38864
[6] G. G. Sherman, P. A. Cooper, A. H. Coovadia, A. J. Puren, S. A. Jones, M. Mokhachane, et al., “Polymerase Chain Reaction for Diagnosis of Human Immunodeficiency Virus Infection in Infancy in Low Resource Settings,” Pediatric Infectious Disease Journal, Vol. 24, No. 11, 2005, pp. 993-997. doi:10.1097/01.inf.0000187036.73539.8d
[7] T. L. Creek, G. G. Sherman, J. Nkengasong, L. Lu, T. Finkbeiner, M. G. Fowler, et al., “Infant Human Immunodeficiency Virus Diagnosis in Resource-Limited Settings: Issues, Technologies, and Country Experiences,” American Journal of Obstetrics & Gynecology, Vol. 197, No. 3, Supplement, 2007, pp. S64-S71. doi:10.1016/j.ajog.2007.03.002
[8] W. Stevens, G. Sherman, R. Downing, L. M. Parsons, C. Y. Ou, S. Crowley, et al., “Role of the Laboratory in Ensuring Global Access to ARV Treatment for HIV-Infected Children: Consensus Statement on the Performance of Laboratory Assays for Early Infant Diagnosis,” Open Chemical Physics Journal, Vol. 2, 2008, pp. 17-25. doi:10.2174/1874613600802010017
[9] National AIDS Control Organization, “Guidelines for Care of HIV Exposed Infants and Children Less than 18 Months 2010 Jan,” National AIDS Control Organisation, India. http://www.nacoonline.org/upload/Care%20&%20Treatment/Monograph%20on%20HIV_CST% 20 division%20_ 21st%20June%202010.pdf
[10] K. K. Jain, R. K. Mahajan, M. Shevkani and P. Kumar, “Early Infant Diagnosis: A New Tool of HIV Diagnosis in Children,” Journal of Community Medicine, Vol. 36, No. 2, 2011, pp. 139-142. doi:10.4103/0970-0218.84134
[11] World Health Organisation. “New Guidance on Prevention of Mother-to-Child Transmission of HIV And Infant Feeding in the Context of HIV,” WHO, Geneva, 2010. http://www.who.int/hiv/pub/mtct/PMTCTfactsheet/en/index.html
[12] J. P. McGowan and S. S. Shah, “Prevention of Perinatal HIV Transmission During Pregnancy,” Journal of Antimicrobial Chemotherapy, Vol. 46, No. 5, 2000, pp. 657-668. doi:10.1093/jac/46.5.657
[13] J. W. Hargrove and J. H. Humphrey, “ZVITAMBO Study Group. Mortality among HIV-Positive Postpartum Women with High CD4 Cell Counts in Zimbabwe,” AIDS, Vol. 24, No. 3, 2010, pp. F11-F14. doi:10.1097/QAD.0b013e328335749d
[14] National AIDS Control Organization, “Prevention of Parent to Child Transmission of HIV,” National AIDS Control Organisation, India. http://www.nacoonline.org/National_AIDS_Control_Program/Services_for_Prevention/PPTCT/
[15] M. Lallemant and G. Jourdain, “Preventing Mother-to-Child Transmission of HIV—Protecting This Generation and the Next,” New England Journal of Medicine, Vol. 363, No. 16, 2010, pp. 1570-1572. doi:10.1056/NEJMe1009863
[16] A. Gupta, N. Gupte, J. Sastry, K. E. Bharucha, R. Bhosale, P. Kulkarni, et al., “BJMC-JHU MIT Study Team. Mother-to-Child Transmission of HIV among Women Who Chose not to Exclusively Breastfeed Their Infants in Pune, India,” Indian Journal of Medical Research, Vol. 126, No. 2, 2007, pp. 131-134.
[17] C. S. Chasela, M. G. Hudgens, D. J. Jamieso, D. Kayira, M. C. Hosseinipour, A. P. Kourtis, et al., “BAN Study Group. Maternal or Infant Antiretroviral Drugs to Reduce HIV-1 Transmission,” New England Journal of Medicine, Vol. 362, No. 24, 2010, pp. 2271-2281. doi:10.1056/NEJMoa0911486

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