Human Immunodeficiency Virus Infections
Description Diagnostic Criteria ICD-10 codes: B20-24 Comprehensive guidelines are available for ART and the care of children with HIV infection in the 2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates . 1 DESCRIPTION Human Immunodeficiency Virus (HIV) is a retrovirus infecting immune cells, especially
Description
Diagnostic Criteria
ICD-10 codes: B20-24
Comprehensive guidelines are available for ART and the care of children with HIV infection in the 2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates.1
DESCRIPTION
Human Immunodeficiency Virus (HIV) is a retrovirus infecting immune cells, especially CD4 T-lymphocytes. In advanced HIV disease, the body loses its ability to fight infections, and this stage is characterised by severe damage to organs, opportunistic infections, malignancies and very low CD4 counts.
In infants, most infections are vertically transmitted, but in adolescents and adults, sexual transmission is the usual route for new infections.
Infants born to mothers with HIV may be:
- HIV-infected.
- 'HIV-exposed':
- At risk of being/becoming HIV-infected.
- HIV-uninfected.
For the purpose of the ART guidelines:
- Children (< 10 years and < 30 kg): follow the Paediatric Antiretroviral Therapy (ART) Guidelines.
- Adolescents (10–19 years): follow the Adult and Adolescent ART Guidelines.
DIAGNOSTIC CRITERIA
All infants/children accessing care should have their HIV status determined.
- Patients with a previously positive HIV test and on ART should not be retested.
- Where mothers tested negative during pregnancy, maternal HIV status should be determined three-monthly whilst breastfeeding.
Confirmation of HIV infection
Children < 18 months of age:
- Birth: Do an HIV PCR at birth in all HIV-exposed infants.
- 10 Weeks: Do an HIV PCR at 10 weeks of age (chronological age) in all HIV-exposed infants.
- 6 Months: Do an HIV PCR at 6 months of age in all HIV-exposed infants.
- The HIV status of all children not already known to be HIV-exposed should be established by offering the mother an HIV test at any time point.
- Post cessation of breastfeeding: If the child is breastfed and previous HIV PCRs were negative, repeat testing 6 weeks after complete cessation of breastfeeding. (If the child is 18 months or older, do an HIV ELISA or rapid test).
- Suspected symptomatic HIV infection: If the child has evidence suggesting HIV infection at any time, even if the child has had a previous negative HIV PCR test, the child should be tested for HIV infection.
- If the HIV PCR is positive at any time point:
- Confirm with a repeat HIV PCR test.
- Initiate treatment while awaiting the second HIV PCR test result.
In children ≥ 18 months of age:
- 18 months: Universal HIV testing at 18 months (HIV rapid test for ALL infants regardless of HIV exposure, except in those who previously tested HIV-positive and are on ART).
- Suspected symptomatic HIV, possible HIV, HIV unknown or Ongoing HIV exposure: Do an HIV rapid or ELISA test.
- If the first rapid test is positive, confirm the result with:
- An HIV PCR test if the infant is between 18–24 months.
- A second rapid test using a different manufacturer kit, preferably on a different blood specimen, if the infant is > 24 months.
Note:
Rapid tests may be less reliable in children with advanced disease. If clinical findings suggest HIV infection, but the rapid test is negative, send a further specimen of blood to the laboratory for formal HIV ELISA testing. If test results are still equivocal, do an HIV PCR test.
Note:
- A child cannot be confirmed as HIV-negative until at least 4–6 weeks after other potential HIV exposure (including cessation of breastfeeding). Exposure to ART through prophylaxis (NVP/AZT) or maternal ART may affect the sensitivity of HIV PCR tests.
- Manage children with discordant or indeterminate HIV test results as per the National Department of Health Guidelines for the Prevention of Mother to Child Transmission of Communicable Infections (HIV, Hepatitis, Listeriosis, Malaria, Syphilis and TB).
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 9: Human Immunodeficiency Virus Infections, 9.1 Human Immunodeficiency Virus Infections
Click here for 9.1.1 The HIV-exposed Infant
Click here for 9.1.2 The HIV-infected Neonate (< 1 Month Of Age)
Click here for 9.1.3 The HIV-infected Infant/child (< 10 Years)