Spectrum: Local Antimicrobial Stewardship, for Yangon Children's Hospital

NAT Available

If infant presents with signs and symptoms of HIV disease, consider starting ART while waiting for NAT result

However, another DBS specimen should be collected prior to starting treatment for late NAT testing to confirm HIV diagnosis

Positive NAT Result

Infant is infected

Immediately start ART

Treatment

Repeat NAT to confirm infection

  • If the second test is negative, a third NAT should be done before interrupting ART

  • As maternal treatment is scaled up and MTCT transmission rates decrease, false-positive results are expected to increase and retesting after a first positive NAT is important to avoid unnecessary treatment, particularly in settings with lower transmission rates

Negative NAT Result

HIV unlikely unless still breastfeeding

  • The risk of HIV transmission remains as long as breastfeeding continues

  • If the 9 months antibody testing is conducted earlier than 3 months after cessation of breastfeeding, infections acquired in the last days of breastfeeding may be missed

    • Retesting at 18 months should be ensured for final assessment of HIV status

Repeat antibody test at 18 months of age or 3 months after cessation of BF or whichever is later

  • If breastfeeding beyond 18 months, final diagnosis of HIV status can only be assessed at the end of breastfeeding

  • If breastfeeding ends before 18 months, final diagnosis of HIV status with antibody testing can only be assessed at 18 months

  • Antibody testing should be undertaken at least 3 months after cessation of breastfeeding (to allow for development of HIV antibodies)

  • For infants <18 months of age, positive antibody testing requires NAT to confirm infection

  • If infant is >18 months, negative antibody testing confirms infant is uninfected; positive antibody testing confirms infant is infected