Early Infant Diagnosis: A New Tool of HIV Diagnosis in Children

BACKGROUND: Standard assay has limited utility in diagnosing HIV reactivity among infants till the age of 18 months by which time, many HIV-infected infants expire. The test for diagnosing infant and children below 18 months is DNA polymerase chain reaction (DNAPCR) either by dried blood spot (DBS) or whole blood sample (WBS). Early infant diagnosis (EID) project is implemented in 18 districts of Gujarat through 33 PPTCT centers from 1st April 2010. Present analysis is done to evaluate factors curbing mother to child HIV transmission. MATERIALS AND METHODS: Study included all children (< 18 months) who are born to HIV-positive mothers or referred children with signs/ symptoms of HIV with unknown parent status or children already on anti-retroviral therapy whose status could not be confirmed by antibody tests. Data was compiled and analyzed according to the infant's age at testing, type of feeding, history of Anti retero viral (ARV) prophylaxis, and type of delivery. Data compiled between April and August 2010 was used for the analysis. RESULTS: Cohort of 326 infants was followed up, fewer infants (14/270) who received ARV prophylaxis tested positive than those who did not (23/56). Transmission was more in normal delivery (29/252) than cesarean (8/74). Low transmission rate was seen in replacement feeding (13/208) than breast/mixed feeding (24/94). Out of 37 samples found positive by the DBS, 17 were sent for WBS and all were found to be positive. CONCLUSION: DBS test results were found as accurate as WBS. So DBS (less cumbersome and cost effective) can be used in future exclusively. Nevirapine administration at birth as mother baby pair showed 36% decrease in MTCT.