I am adopting an 11 mo old that is HIV+. She is in a foreign country. She was just reliquinshed by her mom. What additional tests should I ask the agency to run? Should she be started on meds now? It will probably be 8 months before she is in the U.S. What should they be doing for her during that time? Thank you, adopt mom

It would first be important to obtain any history that you can on the mother. How was her general health? How and when was she diagnosed with HIV? Did she receive any antiviral medications? Did she breastfeed the baby?

It would also be helpful to know when and how the diagnosis of HIV infection was made in the baby. As you know, all babies born to HIV positive women will have HIV antibodies in their blood from their mothers. However, in the absence of antiviral therapy, only about 30% of the mothers will actually transfer the virus to their babies (and the risk of transmission is reduced if moms are receiving antiviral therapy). Antibody tests can not be reliably used to diagnose HIV infection in babies under the age of 18 months but these are the only available tests in many settings where HIV is common. Definitive diagnosis of HIV infection children under 18 months usually requires the detection of HIV nucleic acids in an infant's plasma or blood cells through the use of a technique called the "polymerase chain reaction" (PCR).

It would also be helpful to know how the baby's health has been in general. Has she been growing and gaining weight? Has she shown any possible signs or symptoms of HIV? Common signs or symptoms of HIV in infants may include thrush -- a white fungal coating of the tongue; frequent or severe diaper rashes; enlargement of the liver or spleen; poor growth; developmental delay. If a definitive diagnosis of HIV has been made, have CD4 counts and viral load measurements been done? Has she received any antiviral therapy? You might wish to reveiw the "Guidelines for the Use of Antiretroviral Agents in Children", available on this web site under the "Treatment Guidelines" section of this web site. This document provides an extensive review and recommendations regarding HIV diagnosis and treatment in children.

Finally, it would be important to know whether she has been evaluated for other infections. Her risk for other infections may vary with her country of origin but it would be important to know whether she has also been evaluated for syphilis, hepatitis B and C, tuberculosis, and parasites. Which childhood immunizations has she received?

This is a lot of information -- please feel free to write back with any questions that arise. You don't mention where you live but many medical centers have pediatricians with expertise in caring for children who are adopted internationally; there are also many centers around the US that have pediatricians who specialize in HIV diagnosis and treatment in children. You might wish to ask your pediatrician for a referral so that they can help you to obtain care for your baby and plan for her arrival.