Guideline

WHO recommendations on the diagnosis of HIV infection in infants and children

Year of Publication

2010

Issuing Institution

WHO

Links

WHO IRIS,WHO IRIS,Google Scholar

Recommendations

12 included recommendations

It is strongly recommended that HIV serological assays used for the purpose of clinical diagnostic testing have a minimum sensitivity of 99% and specificity of 98% under quality assured laboratory conditions

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

It is strongly recommended that HIV virological assays used for the purpose of clinical diagnostic testing (usually at or after 6 weeks of age) have a sensitivity of at least 95% and ideally greater than 98%, and specificity of 98% or more under quality-assured, standardized and validated laboratory conditions

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

It is strongly recommended that HIV virological testing be used to diagnose HIV infection in infants and children below 18 months of age

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

In infants and children undergoing virological testing, the following assays (and respective specimen types) are strongly recommended for use: HIV DNA on whole blood specimen or DBS; HIV RNA on plasma or DBS; Us p24 Ag on plasma or DBS

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

It is strongly recommended that all HIV-exposed infants have HIV virological testing at 4–6 weeks of age or at the earliest opportunity thereafter

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

In infants with an initial positive virological test result, it is strongly recommended that ART be started without delay and, at the same time, a second specimen is collected to confirm the initial positive virological test result. Do not delay ART. Immediate initiation of ART saves lives and should not be delayed while waiting for the results of the confirmatory test

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

It is strongly recommended that test results from virological testing in infants be returned to the clinic and child/mother/caregiver as soon as possible, but at the very latest within four weeks of specimen collection. Positive test results should be fast-tracked to the mother–baby pair as soon as possible to enable prompt initiation of ART

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

It is strongly recommended that all infants with unknown or uncertain HIV exposure being seen in health-care facilities at or around birth or at the first postnatal visit (usually 4–6 weeks) or other child health visit have their HIV exposure status ascertained

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

It is strongly recommended that HIV-exposed infants who are well undergo HIV serological testing at around 9 months of age (or at the time of the last immunization visit). Infants who have reactive serological assays at 9 months should have a virological test to identify HIV infection and the need for ART

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

It is strongly recommended that infants with signs or symptoms suggestive of HIV infection undergo HIV serological testing and, if positive (reactive), virological testing

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

It is strongly recommended that children (18 months or older) with suspected HIV infection or HIV exposure have HIV serological testing performed according to the standard diagnostic HIV serological testing algorithm used in adults

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

In sick infants in whom HIV infection is being considered as an underlying cause of symptoms and signs, and virological testing is not available, HIV serological testing and use of the clinical algorithm for presumptive clinical diagnosis of HIV infection is strongly recommended.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate