HIV Infection (Age 2 months up to 5 years)

Click here to open the above PDF

Has the Child been Tested for HIV Infection?

If Yes, Ask

• What was the result?
• If the test was positive, is the child on ART?
• If the test was negative, was the child still breastfeeding at the time that the test was done, or had the child been breastfed in the 6 weeks before the test was done? Is the child still breastfeeding?

HIV Testing in Children

• All HIV-exposed infants should have been tested at birth. Ensure you obtain the result.
• If the test was negative, re-test:
  - At 10 weeks of age— all HIV-exposed infants
  - At 6 months of age— all HIV-exposed infants
  - If the child is ill or has features of HIV infection
  - 6 weeks after stopping breastfeeding
  - Universal HIV rapid test at 18 months for all infants, regardless of HIV exposure

Below 18 months of age, use an HIV PCR test as the first HIV test. If HIV PCR is positive, do a second HIVPCR test to confirm the child’s status.

Between 18 months and 2 years, use an HIV antibody (rapid) test as the first HIV test, but an HIV PCR to confirm the child’s HIV status. HIV PCR should be used to confirm any positive HIV test up to 2 years.

2 years and older, use an HIV antibody (rapid) test as the firsts HIV test. If positive, use a confirmatory HIV antibody (rapid) test kit. If the confirmatory test is positive, this confirms HIV infection. If the second test is negative, refer for ELISA test and assessment.

Classify for HIV Infection in the Child

HIV Infection
Positive HIV test in child. OR Child on ART	Follow the six steps for initiation of ART  Give cotrimoxazole prophylaxis from 6 weeks  Ask about the caregiver’s health and manage appropriately Provide long term follow-up
HIV-Exposed: On ARV Prophylaxis
Infant is receiving ARV prophylaxis	Complete appropriate ARV prophylaxis  Repeat HIV PCR test according to testing schedule. Reclassify on the basis of the test result. Ask about the caregiver’s health, and ensure that she is receiving the necessary care and treatment. Provide follow-up care
Ongoing HIV Exposure
Negative HIV test AND Child still breastfeeding or stopped breastfeeding < 6 weeks before the test	Complete appropriate infant ARV prophylaxis  Repeat HIV testing when indicated. Reclassify the child based on the test result Provide follow-up care
HIV-Negative
Negative HIV test AND All breastfeeding stopped ≥6 weeks before the test	Consider other causes if child has features of HIV infection (repeat HIV test if indicated)

Ask 

• Ask the mother if she had an HIV test. If yes, what was the result?
• If the test was positive, is the child on ART?
• If the test was negative, was the child still breastfeeding at the time that the test was done, or had the child been breastfed in the 6 weeks before the test was done? Is the child still breastfeeding?

Features of HIV Infection

Ask:

• Does the child have PNEUMONIA now?
• Is there PERSISTENT DIARRHOEA, now or in the past 3 months?
• Has the child ever had ear discharge?
• Is there low weight?
• Has weight gain been unsatisfactory?

Look and feel:

• Any enlarged lymph glands in two or more of the following sites - neck, axilla or groin?
• Is there oral thrush?
• Is there parotid enlargement?

Classify for HIV Infection

Suspected Symptomatic HIV Infection
3 or more features of HIV infection	Counsel and offer HIV testing for the child. Reclassify the child on the basis of the test result Counsel the caregiver about her health, offer HIV testing (if mother tests HIV positive: offer same-day initiation) Provide long-term follow-up
HIV-Exposed
Mother HIV-positive	Give infant ARV prophylaxis  Counsel and offer HIV testing for the child. Reclassify based on the test result Counsel the caregiver about her health, and provide treatment as necessary If mother is not on ART: start ART immediately If mother is on ART: check the mother’s VL and if suppressed repeat VL every 6 months while breastfeeding Provide long-term follow-up
Possible HIV Infection
One or two features of HIV infection	Provide routine care including HIV testing for the child. Counsel the caregiver about her health, offer HIV testing and treatment as necessary. Reclassify the child based on the test results
HIV Infection Unlikely
No features of HIV infection	Provide routine care including HIV testing for the child and caregiver. (If mother is HIV negative, retest at the 10 week visit, 6 month visit and every 3 months while breastfeeding)

---

Integrated Management of Childhood Illness 2022; Child (Age 2 months up to 5 years); Assess, Classify and Identify Treatment; HIV Infection 

---

Last checked for updates: June 2023