What mothers need to know about same-day HIV testing for infants

During the birth of Aliyu, Mrs Ronke Adeyemi was transfused with blood at a private health facility during delivery. It was during her second pregnancy that they found she had been infected with HIV as a result.

Aliyu was found to be living with HIV after being rushed to the hospital with a high fever. For her second pregnancy, Mrs Adeyemi, now on HIV anti-retroviral medicine, had to wait 12 months before finding out that her son was HIV-negative.

By the time of her third pregnancy, however, things had changed dramatically. Within a few days of her birth, Mrs Adeyemi had been told that her daughter was HIV-negative. A point-of-care HIV testing of infants had by then been introduced, significantly cutting the time for diagnosis.

Today, HIV science and diagnostics are becoming ever more sophisticated. A point-of-care HIV diagnostic method for infants would yield an HIV diagnosis a mere two hours after collecting blood.

In a large, randomised study in Mozambique and Tanzania, LIFE study investigators reported at the 30th Conference on Retroviruses and Opportunistic Infections (CROI 2023) that point-of-care viral load testing for infants and rapid initiation of antiretroviral treatment reduced deaths among infants with HIV by 67% in the first six months after birth.

The study also showed that measuring mothers’ viral load at delivery using a point-of-care test resulted in more infants being flagged as ‘high risk’ for HIV acquisition.

Infants flagged as ‘high risk’ for HIV acquisition were also more likely to receive enhanced postnatal prophylaxis if their mothers had received a point-of-care viral load test.

The LIFE study was designed to investigate whether infant point-of-care viral load tests at birth led to a reduction in deaths and an improvement in viral suppression when compared to the standard practice of testing for HIV at approximately six weeks after birth.

During the study, 124 infants were diagnosed with HIV (1.9% of participants). More than half of infants (51%) were diagnosed at birth, 32% by six weeks of age, and 16% by 12 weeks of age. Just under 9% of the infants’ mothers were not on antiretroviral treatment at the time of delivery, and 90% of mothers had viral loads above 1000 copies/mL at delivery.

“Testing at birth for HIV is much more for infants because HIV runs a faster course in children than adults. For instance, if a child was born with HIV today and you did nothing, half of them would have died before their second birthday,” said Dr Avese Torbunde, the country manager for the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF).

Currently, in many African countries, less than half of infants exposed to HIV are tested for the virus, and many carers never receive test results. Even when an infant is diagnosed with HIV, less than half start antiretroviral treatment.

Professor Rosemary Ugwu, a consultant paediatrician at the University of Port Harcourt Teaching Hospital (UPTH), stated that testing every child born to any HIV-positive mother despite viral suppression in the mother is important.

Having viral load suppression only reduces the risk of mother-to-child transmission; it does not mean that the child is not HIV-exposed. Also, the risk of the child acquiring HIV is far less, but it is not zero.

HIV transmission to the child is higher in mothers who only found out during the pregnancy that they had HIV. In some cases, they started ART late into the pregnancy, even during labour.

In Nigeria, testing HIV-exposed infants at birth is incorporated into the national guidelines. In fact, EGPAF is sponsoring point-of-care HIV testing in some centres, for example, in River State. Within 24 hours, they can tell who is infected and who is not.

“From 2007, when early infant diagnosis was introduced, we could diagnose HIV in infants at 6 weeks. That is the standard, until we see much more improvement and the tests could be done at birth and then verified at 6 weeks,” Professor Ugwu added.

According to her, early infant diagnosis will improve child survival because the result ends up making the parent more proactive about vaccination, drugs, and other preventive steps to improve the chances of the child surviving and ensure good health.

Dried blood spot (DBS) testing is simple; no sophisticated equipment or invasive testing methods are needed. After a prick on the newborn’s heel, a drop of blood is collected on filter paper and dried.

The sample is sent to a laboratory for testing, and the results are known before the infant is a month old, allowing infants living with HIV to be treated immediately with life-saving antiretroviral medicines.

Diagnosing infants quickly, retaining them in care, and providing them with treatment as soon as possible is critical, as infants with HIV are at high risk of death during the first months of life without appropriate treatment.

Children who are treated early fare better, and the more the medicines work, the more confident parents become. Today, in part as a result of DBS, more children living with HIV access antiretroviral therapy.