Early infant diagnosis of HIV in India—Early results and sero-positivity determinants

Abstract

Introduction: PMTCT under NACP-III cover ex-posed children born to sero-positive mothers. Baby’s sero-status could be confirmed only at 18 months. Under EID, by DBS and/or WB collection, DNA-PCR can be performed earlier, with subsequent ART-linkage and 18-months-con- firmation. In Ahmedabad, with 55,000 annual pre- gnancy-HIV-testing, sero-prevalence is 0.27%. Methodology: Entry-points in EID are at 6 weeks, 6 months or 12 months. Cohort of 213 exposed children since EID roll-out (June 2010-December 2011) at all tertiary care hospitals under Ahme-dabad Municipal Corporation was assessed for sero-positivity-prevalence, DBS validity and assessment of baby’s sero-status-determinants. De-identified, secondary data were captured under routine public-health-program. Necessary permissions taken. Results: 144 HIV sero-positive deliveries took place. 213 exposed children were enrolled in EID. Cumulatively, 18 (8.45%) were tested positive at all entry-points. Out of sero-positives confirmed at 18 months, 60% children’s mothers were detected either in second or third trimester. In 40%, mothers remained undiagnosed intra-partum. Mothers were not on ART intra-partum in 80% (RR 1.8). Peri-partum ARV prophylaxis-single-dose-Nevirapine (sdNVP) was not given in 60%. [RR 18, CI 3.69 to 87.70 at 95% (p < 0.0003)]. In 60%, mode of delivery was vaginal, deliveries were handled in emergency. History of exclusive breastfeeding was in 60%. Discussion: Rise in yield of sero-positivity with age, highest proportion of sero-positivity and highest number of entrants at 6 weeks call for efforts targeted towards increasing earliest EID uptake clubbed with immunization visits. Feasibility, validity and early-ART-linkage to reduce mortality are features of DBS. Results justify its use in national program. Earliest pregnancy-HIV detection, HIV-testing for emergency deliveries, intra-partum sdNVP to both mother and baby, ART-linkage of eligible mothers and following infant feeding guidelines remain cornerstone of PMTCT success.