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Virologic testing schedules for infants exposed to HIV according to perinatal HIV transmission risk

Virologic testing schedules for infants exposed to HIV according to perinatal HIV transmission risk
Risk category Definition Testing schedule*
High risk: Infants born to mothers with HIV who:
  • Did not receive prenatal care, and/or
  • Did not receive antepartum ARVs or only received intrapartum ART therapy, and/or
  • Received ART late in pregnancy (during the late second or third trimester), and/or
  • Received a diagnosis of acute HIV infection during pregnancy or in labor, and/or
  • Had detectable HIV viral loads (≥50 copies/mL) close to the time of delivery, including those who received ART but did not have sustained viral suppression
 Perform virologic testing with NAT at the following ages:
  • Birth
  • 14 to 21 days
  • 1 to 2 months
  • 2 to 3 months
  • 4 to 6 months
All infants at high risk of perinatal HIV transmission should have specimens obtained for HIV testing at birth before initiating an ARV drug regimen; however, presumptive HIV therapy should not be delayed
Low risk: Infants born to mothers who:
  • Received standard ART during pregnancy, and
  • Had sustained viral suppression (usually defined as <50 copies/mL), and
  • Were adherent to their ARV regimen
 Perform virologic testing with NAT at the following ages:
  • 14 to 21 days
  • 1 to 2 monthsΔ
  • 4 to 6 months
This table summarizes the recommended schedule for virologic testing in infants born to HIV-infected mothers according to the risk of perinatal transmission. To identify HIV infection in infants, HIV virologic testing must be performed using assays that detect HIV DNA or RNA, collectively referred to as "nucleic acid tests" (NATs). A positive result at any point should be confirmed as soon as possible with a repeat NAT. For additional information, refer to UpToDate topic on diagnostic testing for HIV in infants.
ARV: antiretroviral; ART: antiretroviral therapy; NAT: nucleic acid test.
* The suggested time points for testing listed above are for infants born to HIV-infected mothers who are not breastfeeding. People with HIV should be encouraged to avoid breastfeeding. Monitoring of infants born to people with HIV who opt to breastfeed after comprehensive counseling should include virologic testing with a NAT according to the high-risk schedule summarized above. In addition, many experts recommend subsequent testing every 3 months throughout breastfeeding, followed by monitoring at 4 to 6 weeks, 3 months, and 6 months after cessation of breastfeeding.
¶ For high-risk infants, virologic diagnostic testing is recommended at birth. For infants treated with multiple ARVs in the first 2 to 4 weeks of life, additional virologic testing is recommended 2 to 6 weeks after ARV drugs are discontinued (ie, at 8 to 12 weeks after birth).
Δ For low-risk infants, testing may be timed to occur at least 2 weeks after cessation of ARV prophylaxis.
Reproduced from: National Institutes of Health. Diagnosis of HIV Infection in Infants and Children. Available at: https://clinicalinfo.hiv.gov/en/guidelines/pediatric-arv/diagnosis-hiv-infection-infants-and-children?view=full (Accessed on February 21, 2022).
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