Integration of statistical theory and practical clinical expertise. Polymerase chain reaction testing of the HIV-exposed infant.
Testing of the human immunodeficiency virus (HIV)-exposed infant has improved markedly over the past decade. Polymerase chain reaction (PCR) technology has made accurate diagnosis possible by 4 months of age and improved sensitivity and specificity of PCR testing has obviated the need for serologic follow-up for most HIV-exposed infants. Clinicians may use PCR testing and simple statistical theory to develop a rational algorithm for diagnosis of HIV-exposed infants. Physicians should determine whether the infant is at low, moderate, or high risk for acquiring HIV. After risk-stratification the physician may proceed with 2 PCR tests, 3 PCR tests, or PCR testing and serologic follow-up. Infants of mothers who are on highly active antiretroviral therapy (HAART) at delivery, whose mothers have a low or undetectable viral load at delivery, and who do not breast-feed, should be considered low-risk. These low-risk infants should have 2 PCR tests, 1- and 4-months post partum. Infants whose mothers have an unknown or high viral load at delivery and who do not breast-feed should be considered moderate-risk. These infants should have 3 negative PCR tests, 1 during the first month of life, 1 after the first month of life, and 1 after 4 months of life. Infants who breast-feed should be considered high-risk and require at least 3 negative PCR tests, PCR testing every 3 months until breast-feeding stops, and serologic follow-up. Any positive PCR test requires virologic confirmation and serologic follow-up.
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