12. Annexes
Establishing the presence of HIV infection in HIV-exposed infants and children less than 18 months of age in resource-limited settings. Source: Adapted from Antiretroviral therapy for HIV infection in infants and children: towards universal access. Recommendations for a public health approach. 2010 revision. Geneva, World Health Organization, 2010 (http://whqlibdoc.who.int/ publications/2010/9789241599801_eng.pdf). HIV-exposed infant or child <18 months Conduct diagnostic viral testa Viral test available
Positive
Viral test not available
Negative
Infant or child is likely infected
Never breastfed
<24 months: immediately start ARTb
Infant or child is uninfected
And repeat viral test to confirm infection
Infant or child develops signs or symptoms suggesting HIV
Ever breastfed or currently breastfeeding Infant or child remains at risk of acquiring HIV infection until complete cessation of breastfeedingc
Infant remains well and reaches 9 months of age Conduct HIV antibody test at approximately 9 months of age
Viral test not available
Positive
Viral test available
Negative
Regular and periodic clinical monitoring
Positive
Negative
Viral test not available: assume infected if sick; assume uninfected if well
Infant or child is HIV infected
sick
Start ARTb and repeat viral test to confirm infection
well
HIV unlikely unless still breastfeedingc
Repeat antibody test at 18 months of age and/or 6 weeks after cessation of breastfeeding For newborns, test first at or around birth or at the first postnatal visit (usually 4â&#x20AC;&#x201C;6 weeks). See also Table 5.1 on infant diagnosis. Start ART, if indicated, without delay. At the same time, retest to confirm infection. c The risk of HIV transmission remains as long as breastfeeding continues. a b
Annex 5 Algorithm for early infant diagnosis
Annex 5. Algorithm for early infant diagnosis
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