Version July 2025
| Risk category | Definition | Testing schedule |
| High-risk formula-fed infants: | Infants born to mothers with HIV who:
| Perform virologic testing with NAT at the following ages:
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:
| Perform virologic testing with NAT at the following ages:
|
| Breastfed infants: | Infants who are breastfed by a mother with HIV | Perform virologic testing with NAT at the following ages:‡
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. |
ART: antiretroviral therapy; ARV: antiretroviral; DNA: deoxyribonucleic acid; HIV: human immunodeficiency virus; NAT: nucleic acid test (DNA or RNA); RNA: ribonucleic acid.
* Viremia can be documented by a laboratory test or presumed from other clinical factors (eg, new diagnosis, ART adherence challenges, interruption in ART prior to delivery).
¶ 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).
Δ If a high-risk infant is breastfed, HIV testing should continue past 4 to 6 months based on the schedule outlined for low-risk breastfed infants.
◊ Sustained viral suppression is defined as HIV RNA <50 copies/mL on at least 2 consecutive tests obtained at least 4 weeks apart. However, when laboratory testing results are not available, it can be based on the clinical judgment of clinicians.
§ Testing at birth is not necessary for infants at low risk that are not being breastfed but may be done if there are concerns that the newborn could be lost to follow-up and not receive further testing.
¥ For low-risk infants, testing may be timed to occur at least 2 weeks after cessation of ARV prophylaxis.
‡ 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.
