Virologic testing schedules for infants exposed to HIV according to perinatal HIV transmission risk

Risk category	Definition	Testing schedule
High-risk, formula-fed infants:	Infants born to mothers with HIV who: Did not receive prenatal care, and/or Did not receive antepartum ARVs or only received intrapartum ART therapy, and/or Received ART late in pregnancy (during the late second or third trimester), and/or Received a diagnosis of acute or primary HIV infection during pregnancy or in labor, and/or Had detectable HIV viral loads (≥50 copies/mL) close to the time of delivery, including those who received ART but did not have sustained viral suppression	Perform virologic testing with NAT at the following ages: Birth* 14 to 21 days 1 to 2 months 2 to 3 months* 4 to 6 months All infants at high risk of perinatal HIV transmission should have specimens obtained for HIV testing at birth before initiating an ARV drug regimen; however, presumptive HIV therapy should not be delayed
Low-risk, formula-fed infants:	Infants born to mothers who: Received standard ART during pregnancy, and Had sustained viral suppression (usually defined as <50 copies/mL), and Were adherent to their ARV regimen	Perform virologic testing with NAT at the following ages: 14 to 21 days 1 to 2 months^¶ 4 to 6 months
Breastfed infants:	Infants who are breastfed by a mother with HIV	Perform virologic testing with NAT at the following ages:^Δ Birth* 14 to 21 days 1 to 2 months 2 to 4 months^◊ 4 to 6 months Then every 3 months throughout breastfeeding 4 to 6 weeks after cessation of breastfeeding 3 months after cessation of breastfeeding 6 months after cessation of breastfeeding All breastfed infants should have specimens obtained for HIV testing at birth before initiating an ARV drug regimen; however, ARV prophylaxis should not be delayed

This table summarizes the recommended schedule for virologic testing in infants born to mothers with HIV according to the risk of perinatal transmission. To identify HIV infection in infants, HIV virologic testing must be performed using assays that detect HIV DNA or RNA, collectively referred to as "nucleic acid tests" (NATs). A positive result at any point should be confirmed as soon as possible with a repeat NAT. For additional information, refer to UpToDate topic on diagnostic testing for HIV in infants.

ARV: antiretroviral; ART: antiretroviral therapy; NAT: nucleic acid test.

* For high-risk infants, virologic diagnostic testing is recommended at birth. For infants treated with multiple ARVs in the first 2 to 4 weeks of life, additional virologic testing is recommended 2 to 6 weeks after ARV drugs are discontinued (ie, at 8 to 12 weeks after birth).

¶ For low-risk infants, testing may be timed to occur at least 2 weeks after cessation of ARV prophylaxis.

Δ If the mother has a detectable viral load and continues breastfeeding, we prefer monthly virologic testing of the infant while the mother remains viremic.

◊ An additional virologic test should be performed at age 2 to 4 months if the gap between the tests at ages 1 to 2 months and 4 to 6 months is greater than 3 months.

Adapted from: National Institutes of Health. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection: Diagnosis of HIV Infection in Infants and Children. Available at: https://clinicalinfo.hiv.gov/en/guidelines/pediatric-arv/diagnosis-hiv-infection-infants-and-children?view=full (Accessed on March 6, 2023).

Graphic 135007 Version 2.0

خرید پکیج

Virologic testing schedules for infants exposed to HIV according to perinatal HIV transmission risk