Early Detection of Perinatal Human Immunodeficiency Virus (HIV) Type 1 Infection Using HIV RNA Amplification and Detection

Early diagnosis of perinatally transmitted human immunodeficiency virus type 1 (HIV) infection can guide early interventions. HIV coculture and DNA polymerase chain reaction (DNA-PCR) detect few HIV-infected infants at birth and 90%-100% by age 3 months. Because extracellular HIV RNA may appear soon after infection, a plasma HIV RNA assay was compared with DNA­ PCR for early detection of perinatally infected infants. Blood-draw specimens (108) obtained at the same time from 49 HIV-infected infants and 10 specimens from 8 uninfected infants were tested. HIV RNA and DNA-PCR positivity rates were 56% and 33%, respectively, in 36 specimens from 36 infants <28 days of age (binomial test, P = .001). Among 81 specimens obtained after age 14 days, 79 (98%) were positive by HIV RNA testing. No HIV-infected infant specimens were DNA­ PCR-positive and HIV RNA-negative. All specimens from 8 uninfected infants were HIV RNA­ negative. These results suggest that plasma HIV RNA was detectable earlier and more reliably than HIV DNA in perinatal infection. In the United States, nearly all new human immunodefi­ ciency virus (HIV) infections in children are acquired through perinatal transmission. The accurate and timely detection of HIV in early infancy has become increasingly important be