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New test identifies infants’ HIV status early (The Times of India-19 July 2010)

Condition Can Now Be Diagnosed 6 Weeks After Birth Instead Of 18 Months

New Delhi- A simple blood test is now helping India identify the status of children born to HIV positive
mothers as early as six weeks after their birth, instead of 18 months.

Till recently, paediatricians in India, on detection of anti-HIV antibodies in children below 18 months,
could never tell for sure whether they were already infected or the antibodies were transferred to them
from their mother.

Therefore, doctors couldn’t even start the lifesaving Anti-Retroviral Treatment — the only effective way
to treat HIV — on them. This, according to National Aids Control Organization (NACO), led to 33,000
new infants getting the infection every year from their HIV positive mothers.

India, in March, rolled out the highly accurate DNA PCR (polymerase chain reaction) test in the four high
prevalence states of Andhra Pradesh, Karnataka, Tamil Nadu and Maharashtra.

Available in 767 Integrated Counselling and Testing Centres (ICTCs) and 180 ART centres, the DNA
PCR can test the blood sample of a child after it reaches six weeks of age and accurately say whether it is
already infected with HIV or not. The antibody test available before March could only confirm the HIV
status after the child reached 18 months of age.

In the last three months, 45 children have been tested for HIV status. NACO hopes to roll out the test to
10,000 children born to HIV positive mothers by March next year.

“As soon as the child of an HIV positive mother is older than six weeks, his or her blood sample is
collected and transported to seven national labs for testing with DNA PCR which gives us a definitive
diagnosis on the child’s HIV status. The report is available in just a week,” NACO’s ART chief Dr B B
Rewari told TOI before leaving for the International AIDS Conference in Vienna.
Dr Rewari, who will present this data in Vienna, added, “Usually, if such children aren’t put on treatment,
50% of them die within the first year of birth if infected. So early diagnosis and treatment is vital.”

Till now, India has detected 19,000 children with HIV. Unlike other tests, the HIV DNA PCR test does
not rely on presence of antigens or antibodies in blood for diagnosis. Instead, it identifies genetic material
by highlighting sequences of virus within the subject’s DNA.

Experts say all babies born to mothers with HIV are born with HIV antibodies. Babies who are not
infected lose their antibodies by the time they are about 18 months old. However, most babies can be
diagnosed as either infected or uninfected by the time they are three months old by using DNA PCR test.

“The PCR test is more sensitive than the HIV test, and is not used in the standard HIV testing of adults. It
looks for the presence of HIV itself, not antibodies,” a NACO official said.
When a woman is tested HIV positive, she is offered special medical care to reduce the risk of her baby
being infected. Some pregnant women with HIV decide to have their baby. Others choose to have a
termination.

FIGHT OF THEIR LIVES

22.7 lakh Estimated number of Indians who are infected with HIV/AIDS

0.29% Is the prevalence of HIV/AIDS in India

It usually takes 10 years for HIV to become full-blown AIDS

The first AIDS case in India was reported from Chennai, in 1986

Globally, more than 33 million people have AIDS or HIV

Of the above number, half are women

Since the beginning of the epidemic in 1981, 60 million people have got infected with HIV and at least 25
million have died of AIDS since the disease first came to light in 1981

Study- Early treatment lowers death risk 75%

New Delhi- New WHO guidelines released on the sidelines of the International AIDS Conference that
kicked off in Vienna on Sunday said the earlier anti-HIV treatment started, the better.

A randomized trial from Haiti — the first comparing earlier therapy with deferred therapy — found early
treatment reduced the risk of death by 75% and the rate of new tuberculosis diagnoses by half. The
finding has been reported in the latest issue of the “New England Journal of Medicine”.

The study showed that deferred treatment resulted in a 69% increase in the risk of death, compared with
therapy started soon after diagnosis. Antiretrovirals can reduce levels of HIV to below detectable levels
but cannot eradicate the pathogen completely.

According to WHO guidelines, which is also followed by India, when the CD4 count in the infected
person’s blood falls below 200, the patient is to be put on the life-saving ART drugs. Normal CD4 counts
in adults range from 500 to 1,500 cells per cubic mm of blood.

CD4 count also shows how far AIDS has advanced (the stage of the disease), and helps predict the risk of
complications and debilitating infections. According to Daniel Fitzgerald from the Weill Cornell Medical
College in New York, the latest finding supports previous observational evidence that starting treatment
while the immune system is still relatively robust can save lives.

New guidelines say that treatment should be started when a patient’s count of CD4-positive T cells falls to
even 500 cells per microlitre of blood, according to Melanie Thompson of the International AIDS
Society’s guidelines panel.