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Tuesday, July 29, 2014
HIV and AIDS
What Is The Most Efficient Way To Test A Baby For HIV?
My wife and I are going to adopt a newborn from Romania. I understand that AIDS is fairly common over there due to high levels of prostitution. What is the incubation period (if that's the right term) for AIDS? If the baby is tested negative, how certain (if at all) can I be that the baby is free from HIV?
HIV infection is on the rise in Eastern Europe -- mainly because the people there now have access to other people from other parts of Europe and the world (including the US) where HIV is more common. This along with the lack of condoms, good HIV education programs, and voluntary HIV screening sites has helped spread HIV in Romania and other Eastern European countries. There was heightened concern about children with HIV in Romanian orphanages a few years back, because the children commonly recieved vaccinations with unsterilized needles, and small amounts of unscreened blood transfusions -- not because they were born to infected mothers. These practices have largely stopped I am told. Still, all infants should be screened. The testing of infants, however, is somewhat complicated. All infants born to HIV infected mothers will test positive on the conventional HIV antibody test commonly used in the US. This is because all babies inherit antibodies from their mothers at birth, to help protect them until they can make their own antibodies as their immune systems mature. These maternal antibodies can hang around in an infant's body for 6 - 18 months on average. Thus a baby with mom's HIV antibodies at birth is not necessarily infected with HIV. To accurately use the HIV antibody test, you must wait until the child is 18 months of age or older to be sure you are checking for the child's antibodies. HIV is transmitted from an HIV-infected mother to her child in about 30% of cases if the mother has untreated HIV disease. With just using the drug AZT (Retrovir) during the latter part of pregnancy, during labor (intravenously), and giving AZT syrup to the infant for the first 6 weeks of life has decreased this transmission rate to around 8%. More intensive therapy with newer drugs may drive this even lower. I would recommend that the child be tested with an HIV antibody test by a reliable lab now and 6 months later. If these are both negative, I think you can assume that the child is not infected. If the HIV antibody test is postive, this often only means that the mother had HIV infection. To better test for HIV in the child you would want to do either an HIV culture of the child's blood, or an HIV viral load assay that looks for HIV DNA or RNA. If either of these is positive, then the child is infected. I should also mention that children with HIV who are treated with appropriate medications are doing better and better -- just like their adult counterparts. The earlier the HIV is detected and treatment started, the better they do. For some prospective parents, the possibility of a child with special needs including HIV would still be considered for adoption. Obviously this isn't for everyone, and would need to be carefully considered. Good luck.
Kenneth Skahan, MD
Assistant Professor in Infectious Diseases
College of Medicine
University of Cincinnati