Updates were made to the Perinatal Guideline on January 22, 2013, January 29, 2013 and April 3, 2013. For an explanation of the updates, please see the correction notice.
(Last updated:7/31/2012; last reviewed:7/31/2012)
Rapid HIV antibody testing of mothers and/or infants is recommended as soon as possible after birth when maternal HIV status is unknown and rapid HIV antibody testing was not performed during labor. If rapid testing is positive, infant antiretroviral (ARV) prophylaxis should be initiated immediately, without waiting for the results of a confirmatory test. Rapid HIV antibody testing should be available on a 24-hour basis at all facilities with a maternity service and/or neonatal intensive care or newborn nursery. A positive test result in mothers or infants should be presumed to indicate maternal HIV infection until standard antibody confirmatory testing clarifies maternal status. A standard confirmatory test (such as Western blot) should be performed on mothers (or their infants) as soon as possible after the initial positive rapid test.1 A positive HIV antibody test in an infant indicates maternal but not necessarily infant HIV infection; diagnosis of HIV infection in infants younger than age 18 months requires virologic testing. If the confirmatory test on a mother (or infant) is negative, ARV prophylaxis can be discontinued. If the confirmatory test is positive, an HIV DNA polymerase chain reaction (PCR) assay should be obtained urgently from the newborn. If the HIV DNA PCR is positive, ARV prophylaxis should be promptly discontinued and the infant should receive treatment for HIV infection with standard combination antiretroviral therapy according to established Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection.