HIV In International Adoptees

HIV is not a death sentence.  Children with HIV who receive proper therapy (i.e., take medications directed against this infection) can live long, normal lives.  We think of HIV as a chronic disease that will require medication and doctor appointments for the rest of the child's life, but it is survivable.  As with any other chronic illness, it is impossible to predict what one child's HIV disease course will be like, but overall the child can do very well with a family that prepared for this particular kind of medical challenge.

The overwhelming majority of pediatric HIV infections are caused by transmission of the virus from mother to baby during pregnancy and childbirth.  Even with no treatment, only about 25-30% of children born to HIV-positive mothers will become infected.  Fortunately, therapies are now available that greatly reduce this risk of transmission from mother to baby.  An HIV-positive mother who gets optimal treatment during pregnancy and delivery now has less than a 2% risk of transmitting HIV to her baby.  Even if a mother is diagnosed late, there are still interventions that can decrease the risk to the infant.  These measures have greatly reduced the rate of mother-to-child transmission over the past several years.

Despite these advances, children worldwide are still contracting HIV through mother-to-child transmission, for a number of reasons.   One: developing nations often do not have the resources to implement large-scale prevention strategies.  Two: women often are not aware at the time of childbirth that they are HIV positive, or they are not able to get proper prenatal care. In resource-poor countries, these problems greatly limit efforts to reduce HIV in children.

In the International Adoption Clinic, we routinely screen our patients for infectious diseases, including HIV.  We administer two different tests for HIV, ELISA and PCR. ELISA (which stands for Enzyme-Linked ImmunoSorbent Assay) tests whether the child’s blood contains antibodies against HIV. The ELISA antibody test is considered the standard test to diagnose HIV infection, but in children less than 18 months old, it may just mean that the child passively (while in utero, or during birth) absorbed the mother’s HIV antibodies. The ELISA may test falsely positive if the mother was HIV positive but the infection did not actually get transmitted to the child.

Therefore, for children under 18 months old, we use the PCR (polymerase chain reaction) test, which identifies the presence of the virus in the child’s body by growing the virus in a viral culture. PCR testing can also have positive or negative results, so we must repeat the test several times to confirm the accuracy of the result. We follow the recommendations made by the National Institutes of Health, which is to do PCR testing three times: at 14-21 days old, at 1-2 months old, and 4-6 months old. If the child tests negative twice (older than 1 month and again older than 4 months), she is considered negative for HIV. If the child tests positive at any of these intervals, the test is repeated immediately, and two positive results confirm that the child has the HIV virus.

The ELISA test should still be done (regardless of whether the child tested negative twice prior) after 18 months of age (at which time the maternal antibodies should be gone) to confirm either a positive or negative result.  If the child has a positive ELISA, the result should be confirmed with a set of blood tests called a western blot.  Children who are HIV positive are referred to pediatric HIV specialists for care.