Another issue she mentioned was that of discordance. In her experience, many kids who had a positive DNA PCR were found to be negative when ELISA test was done at 18 months. RNA PCR for HIV viral load testing gave 100% sensitivity and specificity, while DNA PCR gives 100% sensitivity and only 54% specificity. Dr Ira Shah attributes this to DNA PCR often being done 'in-house' in India, leading to contamination of the sample. But RNA PCR for viral load testing is an automated PCR, and so no chances of error.
Why early infant diagnosis of HIV is so vital?
dvantage of early infant diagnosis is that together with PPTCT, it reduces prenatal transmission of HIV to infants, improves child survival, and early initiation of ART in perinatally infected children also give hope of remission or functional cure of HIV. There should be integration of early infant diagnosis services with PPTCT.
"To have maximum advantage of early infant diagnosis of HIV, we must have decentralisation as it will reduce the dropout rate of HIV exposed children. Also we must reduce the possibility of false positives by using RNA PCR test for confirmation of diagnosis before starting ART," said Dr Ira Shah.
From children to adolescents
The WHO estimates that 10.3 million youth in the age group 15-24 years are living with HIV. It is believed that the number of adolescents with HIV is increasing in India. yet there is no separate data for HIV infection in adolescents.
Dr Narendra Singh of Imphal explained that HIV positive adolescents belong to two distinct groups - those who acquire HIV perinatally and those who acquire it during their teens. He stressed that management of these two requires different approaches. The perinatally acquired ones go on to adolescence having been on ART since childhood. A majority of them remain oblivious of being HIV infected and a minority of them know their status. For those infected recently, infection is acquired mostly through the sexual route, and in some cases through injecting drug use.
Adolescent HIV is the major driving force for the sustenance of HIV/AIDS in general population. Actively identifying and treating adolescent HIV/AIDS will curb the epidemic and help to decrease number of newly HIV infected people. They have to be counselled properly and made to understand and accept the reality and necessity of life long adherence. When and how to disclose their HIV status to the adolescents is a difficult task and needs to handled very carefully by parents and caregivers.
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