Where to test your child for HIV. Diagnosis of HIV infection in young children

Currently, clinical and laboratory tests have been developed for diagnosis in newborns and children in the first year of life.

A child who has had contact with an HIV-infected mother during the perinatal period can be diagnosed with HIV infection only if the results of virological tests for HIV are positive twice. In this case, the results of the study of umbilical cord blood are not taken into account, since contamination of the test sample with maternal blood is possible. Positive results of double isolation of the HIV strain during a virological study of peripheral blood monocytes or positive results of PCR for DNA or RNA in combination with a single isolation of the HIV strain from monocytes are considered reliable. These two studies are performed at a certain time interval, and the child should not receive breast milk HIV-infected mother.

A child born to an HIV-infected mother is considered not infected with HIV if the above tests consistently give negative results, and the child must be at least 4 months old and should not have received breast milk from an HIV-infected mother.

A child born to an HIV-infected mother may remain serologically positive for HIV for up to 18 months due to persistent maternal antibodies transmitted transplacentally. After reaching the age of 18 months, seropositivity remains only in HIV-infected children; in this case, antibodies to HIV-1 can be detected using enzyme-linked immunosorbent assay (ELISA), immunofluorescence reaction (RIF), and immunoblotting (IV).
If a child, in the absence of agammaglobulinemia, has negative serological reactions upon reaching 12 months of age, such a child is considered not infected with HIV.

Thus, a child under 18 months. is considered infected if he has an HIV culture, a positive PCR, or an HIV antigen detected in two or more tests. A child born to an HIV-infected mother is considered uninfected if two or more negative tests for HIV antibodies are obtained by ELISA between the ages of 6 and 18 months. Or one negative result over 18 months. and there are no other laboratory tests positive for HIV, and there are no AIDS-defining diseases.

Laboratory tests and their interpretation, according to various authors, are given below in table.

Polymerase chain reaction (PCR) detects genomic (proviral) DNA sequences in a polyacrylamide gel using radiolabeled enzyme probes. PCR is highly sensitive; it can detect HIV DNA within 6 months. before antibodies appear. However, due to false positive results, standardization of PCR and the introduction of a fully automated reaction are required [Rakhmanova A. G., 1996].

In newborns, to distinguish maternal antibodies from those caused by HIV infection, HIV-specific IgA and IgM, which do not pass through the placenta, are determined in the blood serum.

Anti-HIV IgM antibodies may appear in infected child at 2-3 months of life, however, their production is not natural with an immature immune system. In this regard, the absence of IgM class antibodies does not yet allow a conclusion to be made about the child being HIV infected. On the contrary, detection of IgA class antibodies is a highly sensitive and specific method for diagnosing perinatal HIV infection in children older than three and especially six months of age.

In the first months of life, children exhibit insufficiency of B-cell immunity, which is manifested by impaired production of antibodies to bacteria and decreased resistance to bacterial infections against the background of severe hypergammaglobulinemia.

During early transplacental infection, the virus is not recognized by the immature immune system and antibodies to HIV are not produced in children.

However, in any case, the final diagnosis of HIV infection in a child born from an HIV-positive mother, in most cases (due to the lack of modern laboratory diagnostics) is established only when the detection of anti-HIV antibodies continues for more than 18 months after birth. Because some of these children may be delayed in developing their own anti-HIV antibodies, standard serologic tests are repeated every 3 to 6 months until the age of three years (if possible, using HIV culture results).

Analyzing various diagnostic criteria for the diagnosis of HIV infection, P. Palumbo and V. Sandra (1998) note that for HIV infection in newborns and children, virological studies are of greater value than serological ones. PCR results or detection of a virus culture in peripheral blood are the most substantiated for the diagnosis of HIV infection.

The p24 antigen can be detected, but is less specific. However, each positive diagnostic test requires repeat testing, as false-positive results are possible.

For example, transplacental infection in newborns may be indicated by weight loss, premature birth, microcephaly, and dyscrania.

There are also other signs of congenital HIV infection - craniofacial dysmorphism (hypertaylorism, wide protruding forehead, receding nasal bridge, protruding philtrum of the upper lip), retardation in psychomotor development, recurrent diarrhea, the presence of blue sclera, progressive neurological symptoms (loss of intelligence , motor disorders, pathological reflexes, paresis). The latter is observed in 10-30% of HIV-infected children, and is usually detected at the age of 6 months.

However, clinical criteria are not always acceptable for children in the first months of life. Great value have various risk factors for birth, for example, drug addiction in parents, their bisexuality, hemophilia of their sexual partners [Rakhmanova A. G., 1996].

In addition, in such children, in the presence of neurological symptoms, it is necessary to exclude toxoplasmosis, cytomegalovirus and herpes infection, brain lymphoma, measles and other viral encephalitis, consequences of birth trauma, and only then connect the pathology of the central nervous system with HIV infection.

Every pregnant woman registered at the antenatal clinic must be tested for HIV twice - at the first visit and in the third trimester. If a positive or questionable test for antibodies to HIV is detected, the woman is immediately sent for a consultation to the AIDS Center to clarify the diagnosis.

Transmission of HIV from mother to child is possible during pregnancy, more often in the later stages, during childbirth and during breastfeeding.

Without preventive measures, the risk of HIV transmission is up to 30%. The risk of infection of the child increases if the mother was infected within six months before or during pregnancy, as well as if the pregnancy occurred in the later stages of HIV infection. The risk increases with a high viral load (the amount of virus in the blood) and low immunity. The risk of infection of the child increases with repeated pregnancies.

With properly carried out preventive measures, the risk of transmitting HIV infection from mother to child is reduced to 2%.

In this brochure you will find information on how to reduce the risk of infection of a child and on the timing of clinical observation of a child at the AIDS Center.

Reducing the risk of mother-to-child transmission of HIV infection

When contacting the AIDS Center, a pregnant woman receives advice from an infectious disease specialist, an obstetrician-gynecologist, or a pediatrician; passes all the necessary tests (viral load, immune status, etc.), after which the issue of prescribing antiretroviral (ARV) drugs to the woman is decided. When ARV drugs are taken correctly, the amount of virus in the blood decreases and the risk of transmitting HIV to the unborn child decreases. The choice of regimen and duration of prescription of ARV drugs is decided individually. Their use has been proven safe for the fetus and the pregnant woman herself. Medicines are issued free of charge according to prescriptions from doctors at the AIDS Center.

The effectiveness of medications should be checked towards the end of pregnancy (laboratory testing for viral load).

A pregnant woman must continue to be monitored at the antenatal clinic at her place of residence.

Prevention of mother-to-child transmission of HIV includes 3 stages:

Stage 1. Taking medications by a pregnant woman. Prevention should begin as early as possible, preferably from 13 weeks of pregnancy, with three drugs and continue until delivery.

Stage 2. Intravenous administration of an ARV drug to a woman during childbirth (“drip”).

Stage 3. Taking medications by a newborn child. The child begins taking medications in the first 6 hours after birth (no later than 3 days). Most children receive zidovudine syrup at a dose of 0.4 ml per 1 kg of body weight twice a day (every 12 hours) for 28 days. In special cases, the doctor may add 2 more drugs to the child for prevention: viramune suspension - 3 days, epivir solution - for one week.

Childbirth takes place in maternity hospitals at the woman’s place of residence. Maternity hospitals in the Moscow region are provided with all the necessary ARV drugs for prevention. The method of delivery (natural birth or cesarean section) is chosen by a joint decision of the infectious disease specialist and obstetrician-gynecologist.

Breastfeeding is one of the ways of transmitting HIV infection (not only breastfeeding itself, but also feeding with expressed milk). All women with HIV infection, without exception, should not breastfeed!

The timing of the examination of children,
born to HIV-infected mothers in the first year of life.

Up to 1 year of age, the child is examined three times:

In the first 2 days after birth, blood is taken in the maternity hospital to be tested for HIV using PCR (detects particles of the virus) and ELISA (detects antibodies - protective proteins produced by the human body for the presence of infection) for delivery to the AIDS Center.
At 1 month of life, blood is taken for HIV using the PCR method in a children's clinic or hospital, in an HIV prevention office at the place of residence (if you have not donated blood at your place of residence, this will need to be done at the AIDS Center at 2 months).
At 4 months of life, it is necessary to come to the AIDS Center of the Moscow Region to examine the child by a pediatrician and test the blood for HIV using the PCR method. The doctor may also prescribe additional tests for your child (immune status, hematology, biochemistry, hepatitis C, etc.).

If you missed one of the examination deadlines, do not put it off until a later time. At the age of 1 month and up to 1 year of life, a child must be tested for HIV using the PCR method at least 2 times!

What do the test results mean?

Positive blood test result for HIV antibodies

All children of HIV-positive mothers are also positive from birth, and this is normal! The mother passes on her proteins (antibodies) in an attempt to protect the baby. Maternal antibodies should leave the blood of a healthy child by 1.5 years (on average).

Positive PCR result

This study directly detects the virus itself, which means a positive PCR may indicate possible infection of the child. The child must urgently report to the AIDS Center for rechecking.

Negative PCR

A negative result is the best result! No virus detected.

A negative PCR test on the second day of a child’s life indicates that most likely the child did not become infected during pregnancy.
A negative PCR test at 1 month of life means that the child was not infected during childbirth. The reliability of this analysis at one month of age is about 93%.
Negative PCR over the age of 4 months - the child is not infected with a probability of almost 100%.

Examinations of children starting from 1 year.

If a child already has negative results of blood tests for HIV using the PCR method, the main research method from 1 year of age is the determination of antibodies to HIV in the child’s blood. The average age when a child’s blood is completely “cleansed” of maternal proteins is 1.5 years.

At 1 year of age, the child donates blood for antibodies to HIV at the AIDS Center or at his place of residence. If a negative test result is obtained, the test will be repeated after 1 month and the child may be removed from the register early. Positive or dubious result testing for antibodies to HIV requires a retake after 1.5 years.
At the age of over 1.5 years, one negative result for HIV antibodies is enough to remove the child from the register if there have been previous examinations.

Deregistration of children

Child's age - over 1 year;
The presence of two or more negative PCR tests over the age of 1 month;
The presence of two or more negative test results for HIV antibodies over the age of 1 year;
Absence breastfeeding within the last 12 months.

Confirmation of the diagnosis of HIV infection in a child

Confirmation is possible at any age from 1 to 12 months upon receipt of two positive HIV PCR results.

For children over 1.5 years of age, the criteria for diagnosis are the same as for adults (the presence of a positive blood test for antibodies to HIV).

The diagnosis is confirmed only by specialists from the AIDS Center.

Children with HIV infection are constantly under the supervision of a pediatrician at the AIDS Center, as well as in the children's clinic at their place of residence. HIV infection can be asymptomatic, but there comes a time when the doctor prescribes treatment for the child. Modern medicines allow you to suppress the immunodeficiency virus, thereby eliminating its influence on the body of a growing child. Children with HIV can lead a full life and attend any child care facilities on a general basis.

Vaccination

Children of positive mothers are vaccinated like all other children according to the national calendar, but with two features:

The polio vaccine must be inactivated (not live).
You will receive permission for the BCG vaccination (vaccination against tuberculosis), which is usually done in the maternity hospital, from the pediatrician of the AIDS Center

Telephone number of the pediatric department: 8-9191397331 (from 09:00 to 15:00 except Thursdays).

We are waiting for you and your children only on Thursdays from 8:00 to 14:00; on other days (except weekends) you can get a consultation with a pediatrician and find out the results of your child’s tests from 09:00 to 16:00.

The health of your child is in your hands!

If you are HIV-infected and plan to have healthy children, you must visit the AIDS Center before pregnancy!

If you are diagnosed with HIV infection during pregnancy, contact the AIDS Center as soon as possible in order to promptly begin preventive measures aimed at reducing the risk of contracting HIV infection to future babies!

The diagnosis of HIV infection is excluded or established in children with perinatal transmission using serological and virological methods. Serological tests are aimed at detecting antibodies to the virus in blood serum using ELISA and immunoblotting. Virological methods (virus isolation, PCR, viral load) make it possible to identify the virus and/or its components - proteins and nucleic acids, in particular gp24-aHTHreH, which is found in significant quantities in viral particles. Rapid and early serological diagnosis of HIV infection in children is difficult, since antibodies IgG class are transmitted transplacentally from the mother and are present in children under 18 months. It is not possible to distinguish between maternal and own antibodies to HIV. In uninfected children, maternal antibodies usually disappear by 9-12 months; this, with a negative PCR, suggests that the child is not infected. The results of serological examination of newborn children are taken into account when making the final diagnosis at any age. However, in some cases, antibodies may not be detected in HIV-positive children. This is due to congenital hypogammaglobulinemia, in which during the period when maternal antibodies have already disappeared (6-18 months), antibodies to HIV antigens are not produced in titers sufficient for detection in ELISA. Thus, a negative serological test result at an early age is not sufficient to conclude that infection is absent.

To establish or completely deny HIV infection in newborns and children in the first year of life, virological tests are recommended.

The most reliable methods are polymerase chain reaction (PCR) (DNA and RNA test) and cultural-virological. Their use makes it possible to establish a diagnosis in 30-50% of HIV-infected children immediately after birth and in almost 100% at the age of 3-6 months. The PCR method is based on the detection of virus nucleic acids - free RNA or proviral DNA in blood lymphocytes, the presence which indicates the multiplication of HIV in the child’s body. For diagnostics HIV infections Both types of tests can be used in children: it has been shown that they do not differ in sensitivity, but the DNA test is much simpler to perform and cheaper. An important condition To obtain reliable results, use only the child’s venous blood for analysis. The PCR method is highly sensitive: a few copies of DNA or RNA in a plasma sample may be enough to test positive. Therefore, cord blood is not suitable for molecular testing. This is due to the possibility of contamination of the baby's blood with maternal blood during childbirth; the slightest admixture of viral particles or lymphocytes HIV-infected mother may result in a false positive LCR test result, which will complicate the correct diagnosis of the child.

According to experts, diagnostic PCR testing should be carried out three times in the following periods: - from birth to 48 hours of life; at the age of 1-2 months; -4-6 months Most experts agree that when infected in uteri, a positive result of a virological examination is observed in the first 48 hours of life. As the child's age increases, the detection of HIV DNA during DNA testing also increases. In the case of perinatal infection, only 24% of infected children are detected in the first 7 days, but after a week their share is 93%. Therefore, most infected children can be diagnosed with HIV infection at 1 month of age. with repeated PCR analysis.

Children who have negative virological testing results at birth and at 1 month of age are examined at 4–6 months of age. By the age of 4-6 months, almost all HIV-infected children have positive PCR test results.

Another test to assess virological status and monitor infection is to determine the viral load - the concentration of the virus expressed as the number of copies of HIV RNA (proportional to the number of viral particles) per 1 ml of plasma. Typical for children high level viral load, which can persist in the child’s body for a long time. It has been shown that during intrauterine infection at the time of birth, the concentration of the virus is relatively low (<10 000 копий/мл), однако в течение первых 2 месяцев жизни резко возрастает (100 000 — 1 000 000 копий РНК/ мл и более) и затем снижается очень медленно в течение нескольких лет. Высокий уровень вирусной нагрузки (более 105/мл в возрасте 1-2 мес. обычно соответствует быстрому прогрессированию ВИЧ-инфекции. Для детей характерны более выраженные биологические колебания концентрации вируса в крови, поэтому в возрасте до 2 лет существенными следует считать не менее чем пятикратные различия показателей (для взрослых — 3-кратные). В результате проведенных исследований в США выявлена зависимость уровня РНК ВИЧ и показателей смертности от пола ребенка. Отмечено, что для мальчиков характерен более высокий уровень РНК ВИЧ, но не смотря на это, выживаемость мальчиков существенно выше выживаемости девочек. Показатели вирусной нагрузки имеют значение для оценки состояния, прогноза и решения вопроса о назначении и эффективности антиретровирусной терапии. При хорошем результате лечения уровень нагрузки падает в 100-1000 раз и может оказаться ниже порога чувствительности тест - системы (так называемый «неопределяемый уровень»).

Thus, in children aged 6 to 18 months. only a combination of two methods—serological and virological—can confirm or reject HIV infection. It is possible to conclude that it is absent in children without clinical signs of HIV infection with two negative results of serological and virological tests. With a combination of positive virological and serological results, infection is confirmed. After 18 months The only confirmation of HIV infection can be the determination of antibodies to HIV in the child’s serum: after this period, they can only be detected there if they are produced by the child’s own immune system in response to contact with the virus.

The presence of immunodeficiency in a woman is not an indication for termination of pregnancy, since with timely preventive measures, the likelihood of infection of the fetus can be reduced to 2%.

Are children tested for HIV? Yes, such a study is necessary if a baby was born from an infected mother. After the baby is 1-2 months old, HIV tests are prescribed for the child.

Diagnosis of HIV infection in children

Immediately after the birth of a child from an infected woman, he is registered at the children's center of the Moscow AIDS Center. The initial diagnosis is "inconclusive testing for human immunodeficiency virus." It is mandatory for children under 1 year of age to visit this medical facility once every 3 months. After the baby reaches this age, visits to the clinic are reduced to once every six months.

Testing children for HIV includes the following tests:

blood for PCR testing;
detection of the presence of antibodies to the retrovirus;
determination of markers of hepatitis B and C (since these diseases often develop against the background of immunodeficiency);
blood test for biochemistry;
in rare cases, the child’s immune status is examined.

Where can I get my child tested for HIV? You can donate blood for HIV to children only in a specialized center that works with young patients with this diagnosis.

How to determine HIV in a child?

Parents whose children may be infected with immunodeficiency often wonder: do their children take a PCR test for HIV? Yes, such a study is often prescribed, as it is quite informative.

The peculiarity of the polymerase chain reaction is that the genetic material of the virus is directly detected. That is, among the many cells and antibodies to the pathogen that entered the child’s body from the mother, it is possible to detect the retrovirus itself. This method makes it possible in most cases to determine the presence of pathogenic microflora the first time.

It is important to note that blood for examination should only be taken from a vein. Biological material obtained from the umbilical cord is not suitable because it may contain elements of the mother's substance. Thus there is a high probability of error.

It should be remembered that the first tests for the presence of the virus are taken within 48 hours after the birth of the baby. If pathogen cells were found in the DNA material of the child, this may indicate the presence of an infection that occurred in the womb. The result can be confirmed only after the baby is 1.5 months old using the PCR method.

In situations where the initial analysis is negative, and a PCR study indicates the presence of a virus, the pathogen is re-determined using polymerase chain reaction. If it again turns out to be positive, then it is concluded that the child was infected during childbirth. If a repeat test gives a negative answer, then a similar screening will need to be carried out, but at the age of 4-6 months. Also in this case, the child’s parents are recommended to conduct enzyme immunoassay.

If at this stage the presence of infection is not determined, then the child is tested again at the ages of 6, 9, 12, 15 and 18 months. This allows you to accurately determine the baby’s health status and confirm or refute the presence of immunodeficiency.

Negative test for HIV in a child

If the child’s blood test for HIV turns out to be negative, then after 3 months the biological material is retested. If the result is identical, the baby is removed from the register at the AIDS Center and is considered healthy. Parents are given the appropriate documents, and they go with them to the children's clinic at their place of residence. From this moment on, the child’s care is provided in this medical institution. But doctors will still order blood tests to determine antibodies to the retrovirus in the baby every 3 months until he reaches 1.5 years.

Positive HIV test in children

It is possible to say with certainty that a child has been diagnosed with HIV only after he turns 1 year old. Upon reaching this age, an HIV test is done. It is almost impossible to accurately determine the presence of the virus in a child, since the baby’s blood contains antibodies to the infection received from the mother. Therefore, if a child has an HIV-positive rapid test, there is no need to panic. You should wait until he is 12-18 months old and re-examine.

It is important to note that an HIV test cannot be carried out without parents in the hospital, that is, their consent and presence is required. In the case of young patients living in an orphanage, the permission is signed by the head of the institution.

In turn, the result can be considered positive if RNA particles of a retrovirus are detected in the child’s blood, which is supported by various types of clinical manifestations of immunodeficiency.

Carrying out the analysis at such an early age is justified by the fact that time is needed to determine treatment tactics and the rate of progression of the infectious process. And, of course, parents must get used to the baby’s social status so that it is easier for him to adapt to society.

If the presence of a retrovirus in a child is confirmed, he will be examined and treated throughout his life at an AIDS control center.

HIV infection is not transmitted to most children born to HIV-positive mothers

Risk of HIV transmission from mother to child

20% - during pregnancy.
60% - during childbirth.
20% - when breastfeeding.

What is necessary for an HIV-infected woman to give birth to a healthy child?

Prevention of vertical transmission (PVT) is a set of measures aimed at preventing the transmission of HIV from mother to child at all possible stages (pregnancy, childbirth, breastfeeding).

Algorithm of preventive measures:

If a pregnant woman is diagnosed with HIV infection, she needs to register with a gynecologist at the AIDS center.
From 24-28 weeks of pregnancy, an HIV-positive pregnant woman should begin taking antiviral drugs (according to the approved protocol) until the time of delivery. The drugs will be given to her at the regional AIDS center free of charge.
The method of delivery is selected individually together with the gynecologist of the AIDS center, according to the approved protocol, depending on the viral load (the amount of virus in the woman’s blood).
If preventive ART is started late (during labor) or if the viral load is high, delivery by cesarean section is recommended to avoid as much as possible the baby's contact with the mother's blood and vaginal secretions.
Immediately after birth, each child born from an HIV-positive mother is prescribed the antiviral drug Zidovudine in syrup for 7 or 28 days. The drug is issued in the maternity hospital for the entire course of treatment.
Breastfeeding is not recommended. Immediately after birth, the child is transferred to artificial feeding with adapted milk formulas.

When carrying out all the above measures, the risk of HIV transmission from mother to child is no more than 1-2%.

Risk factors for mother-to-child transmission of HIV

Stage of maternal HIV infection.
Lack of preventive treatment during pregnancy.
Multiple pregnancy.
Long waterless period.
Premature birth.
Independent childbirth.
Bleeding, aspiration during childbirth.
Breast-feeding.
Injecting drug use, alcohol abuse during pregnancy.
Coinfection (tuberculosis, hepatitis).
Extragenital pathology.

Peculiarities of management of a child born from an HIV-positive mother in the pediatric area

Carefully study the extract from the maternity hospital.
Please note: child vaccination (vaccination against hepatitis B - carried out, BCG not carried out); prophylactic treatment regimen with Zidovudine (7 or 28 days).
Check the mother's availability of Zidovudine syrup and whether she knows about the regimen and duration of taking the drug (2 times a day at the rate of 4 mg/kg for each dose, for 7 or 28 days). Explain to your mother again why she needs to take it (prevention of HIV infection in a newborn).
All children, until their HIV status is clarified, are under the supervision of a pediatrician at the AIDS center, a local pediatrician and a pediatric TB specialist.
The child is examined and treated for all concomitant diseases, at the place of residence, on a general basis.
The child's medical records must be kept separately and out of reach of others, and remember that information about the status of the child and his parents is strictly confidential.
After deregistering a child for HIV infection, it is recommended to replace his outpatient card with a new one, which will not contain information that the child was registered at the AIDS center.

Criteria for registration and deregistration at the AIDS center

For the first examination and examination of the child, it is necessary to receive a referral to the regional AIDS center at the age of 1 month, where he will have his blood drawn to determine HIV RNA using the PCR method and to determine antibodies to HIV using the ELISA method. Further tactics for managing the child depend on the results of the study.

HIV RNA PCR test at 1 month

Negative PCR result