Testing children of HIV-positive parents

There are a number of cases of vertically infected infants who are untested, untreated and survive into adolescence. In the UK between 1998 and 2007, at least 42 vertically infected young people were diagnosed with HIV for the first time aged 13 to 20.1

The vast majority (86%) were born in sub-Saharan Africa and arrived in the UK at a median age of twelve. Although diagnosis occurred a median of two years after arrival, for one in five of this group, it happened five or more years after arrival. Half the young people were tested because of HIV-related symptoms, and CD4 counts tended to be low.

These findings highlight the importance of considering HIV testing for all offspring of HIV-positive women, regardless of age or symptoms. Delayed diagnosis is likely to lead to significant morbidity and mortality, as well as onward transmission as this group becomes sexually active.

Nonetheless parents with diagnosed HIV may be reluctant to test children for a number of reasons. Diagnosis would lead to explanation of the parent's own diagnosis; there may be fears that the child would end up disclosing the parent's status; if the child was positive, the parents might feel guilty or unable to cope.2.

Parents may find it more difficult to accept the idea of testing older, asymptomatic children, especially as testing guidelines recommend that children over the age of eleven should normally give their own consent for the test. However, younger children can be told that they are being tested for a 'bug' in their blood, and pre-school children may not need any formal explanation of why they are having a blood test.3

References

  1. Judd A et al. Vertically acquired HIV diagnosed in adolescence and early adulthood in the United Kingdom and Ireland: findings from national surveillance. HIV Medicine 10: 253-256, 2009
  2. Eisenhunt M Are children of HIV-infected adults in the UK being tested? Luton Adult HIV Clinic Audit. BHIVA Autumn Conference, CHIVA Parallel Sessions, 2008
  3. British HIV Association, British Association for Sexual Health and HIV, Children’s HIV Association. Don’t forget the children: Guidance for the HIV testing of children with HIV-positive parents. Available at http://www.chiva.org.uk/health/conferences/previous/dontforget (accessed 29 April 2010), 2009
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