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Challenges Facing Early Infant Diagnosis of HIV among Infants in Resource Poor Settings

Wasiu O. Adebimpe


The number of children who have HIV continues to grow. Studies have confirmed dramatic survival benefits and mortality reduction for infants confirmed and managed as early as possible after diagnosis. With the advent of the Polymerase Chain Reaction technology, early infant diagnosis of HIV among children is easier and more reliable worldwide. Most HIV programmes in developing countries are donor dependent with less encouraging moves towards sustainability drive by the local health authority. The health systems also face a lot of challenges while implementing these programmes that would promptly identify HIV exposed babies as well as enrolment into care. This review examined challenges facing early infant diagnosis of HIV among infants in Nigeria (Afr J Reprod Health 2013; 17[1]: 122-129).


Le nombre d'enfants qui sont atteints du VIH ne cesse de s’accroitre. Des études ont confirmé les avantages de survie dramatiques et la réduction de la mortalité pour les nourrissons confirmés et gérés le plus tôt possible après le diagnostic. Avec l'avènement de la technologie de Réaction en Chaine de Polymérase, le diagnostic précoce du VIH chez les enfants à travers le monde est plus facile et plus fiable. La plupart des programmes du VIH dans les pays en développement sont dépendent des bailleurs de fonds avec des tentatives moins encourageantes vers la durabilité d'entraînement par l'autorité sanitaire locale. Les systèmes de santé font face également  à de nombreux défis lors de l'exécution de ces programmes qui identifieraient rapidement les bébés exposés au VIH ainsi que leur inscription dans les soins. Ce  compte rendu a étudié les  défis auxquels fait face le diagnostic précoce du VIH chez les nourrissons au Nigeria (Afr J Reprod Health 2013; 17[1]: 122-129).

Keywords: Early Infant Diagnosis (EID), HIV, Dried Blood Spot (DBS), Polymerase Chain Reaction (PCR)

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UNAIDS. AIDS Epidemics Update. Geneva: UNAIDS December 2007.

Federal Ministry of Health. National guidelines on prevention of mother to child transmission of HIV in Nigeria. National AIDS=STI Control Programme (NASCP). Abuja, 2005

Kourtis AP, Bulterys M, Nesheim SR, Lee FK. Understanding the timing of HIV transmission from mother to infant. JAMA.2001;285 :709– 712

WHO, UNICEF. Towards universal access: Scaling up priorities HIV/AIDS intervention in the health sector. Progress report 2008, 2008 Geneva

World Health Organization (WHO). Case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Geneva, Switzerland: World Health Organization; 2006. Available at: Accessed October 29, 2011

National Agency for the Control of HIV/AIDS: National Policy on HIV/AIDS. Abuja Nigeria. October 2009

Lindegren ML, Byers RH Jr, Thomas P. Trends in perinatal transmission of HIV/AIDS in the United States. JAMA.1999;282 :531– 538

Centers for Disease Control and Prevention. HIV/AIDS surveillance report, 2005, volume 17. Accessed

October 29, 2011.Available at: s/2005report/default.htm.

Obimbo EM, Mbori-Ngacha DA, Ochieng JO. Predictors of early mortality in a cohort of human immunodeficiency virus type 1-infected African children. Pediatr Infect Dis J, 2004; 23:536-543.

Pillay T, Adhikari M, Mokili J. Severe, rapidly progressive human immunodeficiency virus type 1 disease in newborns with coinfections. Pediatr Infect Dis J, 2001; 20:404-410.

Spira R, Lepage P, Msellati P. Natural history of human immunodeficiency virus type 1 infection in children: a five-year prospective study in Rwanda. Mother-toChild HIV-1 Transmission Study Group. Pediatrics,

; 104:e56.

Newell M, Coovadia H, Cortina-Borja M. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet, 2004;


Creek T, Tanuri A, Smith M. Early diagnosis of human immunodeficiency virus in infants using polymerase chain reaction on dried blood spots in Botswana's national program for prevention of mother-to-child transmission. Pediatr Infect Dis J, 2008; 27:22-26.

World Health Organization, Division of Diarrhoeal and Acute Respiratory Disease Control. Integrated management of the sick child. Bull World Health Organ. 1995; 73 :735– 740

Gove S. Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines

for Integrated Management of the Sick Child. Bulletin of the World Health Organization 1997;75(1):7-24.

Horwood C, Liebeschuetz S, Blaauw D, Cassol S, Qazi S. Diagnosis of paediatric HIV infection in a primary health care setting with a clinical algorithm. Bull World Health Organ,2003;81 :858– 866

WHO. Multi-country evaluation of IMCI effectiveness, cost and impact. MCE progress report, May 2002 – April 2003. Geneva: World Health Organization; 2003.

World Health Organization. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Geneva, Switzerland: World Health Organization; 2006. Available at: Accessed July 19th 2012

WHO 2008. Mortality profiles [web site]. Geneva, World Health Organization, 2008 Available at, accessed 18 January 2008).

Jones SA, Sherman GG, Coovadia AH. Can clinical algorithms deliver an accurate diagnosis of HIV infection in infancy? Bull World Health Organ, 2005;83 :559– 560

Read, J.S. Diagnosis of HIV-1 Infection in Children Younger Than 18 Months in the United States. NeoReviews, 2007; 120(6): e1547 -e156

Bremer JW, Lew JF, Cooper E. Diagnosis of infection with human immunodeficiency virus type 1 by a DNA polymerase chain reaction assay among infants enrolled in the Women and Infants’ Transmission Study. J Pediatr, 1996;129:198-207.

Charboneau TT, Wade NA, Weiner. Vertical transmission of HIV in New York State: A basis for statewide testing of newborns. AIDS Patient Care STDs, 1997; 11:227-236.

World Health Organization and Joint United Nations Programme on HIV/AIDS (UNAIDS).Guidelines for using HIV testing technologies in surveillance: selection, evaluation, and implementation. Geneva,

World Health Organization, 2001

( EDC_2001.16.pdf).

Nesheim S. Quantitative RNA testing for diagnosis of HIV-infected infants. Journal of Acquired Immune Deficiency Syndromes, 2003; 32(2):192–195.

Fischer A. Simple DNA extraction method for dried blood spots and comparison of two PCR assays for diagnosis of vertical human immunodeficiency virus type 1 transmission in Rwanda. Journal of Clinical Microbiology, 2004; 42(1):16–20.

Beck IA. Simple, sensitive, and specific detection of human immunodeficiency virus type 1 subtype B DNA in dried blood samples for diagnosis in infants in the field. Journal of Clinical Microbiology, 2001; 39(1):29–33.

Pineau F. Reliable diagnosis of neonatal HIV-1 infection by real time PCR in Congo.11th Conference on

retroviruses and opportunistic infections. San

Francisco, USA, Poster, 2004

( 0.htm).

Rouet F et al.Pediatric viral human immunodeficiency virus type 1 RNA levels, timing of infection, and disease progression in African HIV-1-infected children. Pediatrics, 2003; 112(4):e289.

Isaakidis P et al. High survival and treatment success sustained after two and three years of first-line ART for children in Cambodia. Journal of the International AIDS Society, 2010;13(1):11.

Janssens B et al. Effectiveness of highly active antiretroviral therapy in HIV-positive children: evaluation at 12 months in a routine program in Cambodia. Pediatrics, 2007;120(5):e1134–1140.

Sutcliffe CG et al. Effectiveness of antiretroviral therapy among HIV-infected children in sub-Saharan Africa. Lancet Infectious Diseases, 2008; 8(8):477–489.

Prendergast A et al. Early virological suppression with three-class antiretroviral therapy in HIV-infected African infants. AIDS, 2008; 22(11):1333–1343.

Violari A. Early antiretroviral therapy and mortality among HIV-infected infants. New England Journal of Medicine, 2008; 359(21):2233–2244.

Chiappini E et al. Virologic, immunologic, and clinical benefits from early combined antiretroviral therapy in infants with perinatal HIV-1 infection. AIDS, 2006; 20(2):207–215.

WHO 2008. Report of the WHO Technical Reference Group, Paediatric HIV/ART Care Guideline Group Meeting. Geneva, World Health Organization, 2008


WHO_Paediatric_ART_guideline_rev_mreport_2008. pdf).

World Health Organization, Joint United Nations Programme on HIV/AIDS (UNAIDS) and United Nations Children Fund (UNICEF). Towards universal access: scaling up priority HIV/ AIDS interventions in the health sector: progress report 2008. Geneva,

World Health Organization, 2008

( 596886_eng.pdf).

WHO 2007.Guidance on provider-initiated HIV testing and counselling in health facilities. Geneva, World

Health Organization, 2007

( 595568_eng.pdf).

Khalid SK, Daniel W, Lale S. WHO analysis of causes of maternal death: a systemic review. The Lancet Maternal Survival Series, 2006; 367:1066-74

Dotun A. Nigerian National Health Insurance Scheme NHIS. The Nigerian Doctor, 2009;1:23-27

Cook RE, Ciampa PJ, Sidat M, Blevins M, Burlison J, Davidson MA, Arroz JA, et al. Predictors of

Successful Early Infant Diagnosis of HIV in a Rural District Hospital in Zambézia, Mozambique. JAIDS

Journal of Acquired Immune Deficiency Syndromes, 2011; 56(4):e104-e109.


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