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Please Help:17-month old maybe HIV+

Aug 10, 1998

A family member just adopted a 17-month old girl from an orphange in China. They no knowing about the birth mother. Upon returning to the US she was tested for Aids using both ELISA and western blot. The child tested positive using ELISA, but negative with western blot. A PCR test is under way with the results expected in 10 days. Three questions: (1) How encouraged should they be based on the negative western blot? (2) if the PCR test is negative can they be 100% certain that the child does not have AIDS? (Note, the child has been in their care for the last 4 weeks with zero-chance she has had any additional exposure during this 4-week period.) (3) What is the longest period that mother-to-baby transmitted aids antibodies have been observed in infants who themselves are not infected? (I have read 12 -15 months, maybe longer. What has been the empirically observed upper limit? THANK YOU

Response from Dr. Holodniy

Maternal antibodies can be present in newborn babies blood for many months (certainly over 12 months). I am not sure what the upper limit is. A positive ELISA and negative western blot is good evidence, but not definitive, that the baby is not infected. A negative PCR test (either plasma viral load or HIV cell DNA PCR) 17 months after birth would be pretty conclusive. The first 4 weeks of life are the hardest time to diagnose HIV infection, because antibodies are positive and PCR may be negative. After 4 weeks, PCR testing is very definitive. MH



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