HIV during pregnancy: chances for my baby

Question

Dear Dr. Frascino, first of all, thank you for your time and commitment to helping people. I am HIV+ young female. I do not know how and when I got the virus, but I always had viral load less than 48 copies/ml. I eventually got pregnant and was on HAART during 2&3 trimesters. I delivered vaginally, my son received ZVD prophylaxis and I never breastfed him to avoid any further risk. I week ago (at his age of 1 mo) we tested my baby in our HIV clinic for viral DNA, and the results came out negative. My doctor said that after 4 weeks the viral DNA PCR is a very sensitive and specific test, and that my baby is 100% not infected. IS THAT TRUE? We have another appointment in 3 mo to repeat the test. Please comment on results of the negative viral DNA PCR, and chances of turning into something different within next 3 months. Thank you so much for your generous answer. Trisha

Answer

Hi Trisha,

Virology assays, including HIV-1 DNA, represent the gold standard for diagnostic testing of infants less than 18 months of age. (For those over 18 months of age, HIV-antibody tests are the recommended testing assays.)

In non-breastfeed infants an undetectable HIV PCR DNA test at one month is indeed both a very sensitive and specific test for HIV disease.

The current guidelines recommendation for HIV diagnostic testing in infants less than 18 months born to HIV-positive moms is an HIV-1 DNA or RNA assay at 14 days, 1-2 months and 3-6 months. If any of these tests are positive, a repeat test is recommended to confirm the diagnosis. Definitive exclusion of HIV-1 infection is based on two negative virologic test results, one obtained at one month of age or older and one obtained at four months of age or older.

The chances your baby is HIV negative are excellent.

Happy Mother's Day!

Dr. Bob