Grading: 1D Where a woman chooses to breastfeed against the medical advice in Recommendation 8.4.2, she and the baby should be monitored regularly for maternal adherence to ART; VL monitoring of the mother and diagnostic testing of the baby should be performed regularly (monthly). If the mother’s Trichostatin A supplier adherence is suboptimal

or she has detectable viraemia or an intercurrent illness that affects her ability to take or absorb ART, or she develops mastitis, she should be advised again to stop breastfeeding. 8.4.5 All infants born to mothers infected with HIV should have an antibody test at age 18 months. Grading: 1C The potential for breastfeeding emphasizes the possibility of late transmission of HIV after the standard 3-month PCR test. Babies known to be breastfed should be tested monthly by PCR as above, but not all breastfeeding will be disclosed, and all babies born to HIV-positive women should have a negative HIV antibody test documented at age 18 months

(see Section 8.5: Infant testing below). 8.5.1 HIV DNA PCR (or HIV RNA testing) should be performed on the following occasions (Grading: 1C): During the first 48 h and before hospital discharge. AZD6244 2 weeks post infant prophylaxis (6 weeks of age). 2 months post infant prophylaxis (12 weeks of age). On other occasions if additional risk (e.g. breastfeeding). HIV antibody testing for seroreversion should be checked at age 18 months. The gold standard test for HIV infection in infancy was HIV DNA PCR on peripheral blood lymphocytes, although a number of studies, including the large French perinatal cohort have now demonstrated equal or increased early sensitivity with amplification of viral RNA with no false positives [71]. Infants infected intrapartum may have low

peripheral blood HIV levels, so HIV DNA/RNA may not be amplified from all infected infants at birth. Indeed a positive HIV DNA PCR result within 72 h of birth is taken as presumptive evidence of intrauterine transmission. Within Epothilone B (EPO906, Patupilone) the first few weeks of life, sensitivity of the viral diagnostic tests increases dramatically and by 3 months of age, 100% of non-breastfed HIV-positive infants are likely to be detected [72]. In view of the genomic diversity of HIV where infant diagnosis will rely on HIV DNA amplification, a maternal sample should always be obtained for HIV DNA amplification with, or prior to, the first infant sample to confirm that the primers used detect the maternal virus. If the maternal virus cannot be detected then a different primer set and/or test should be used. Infant HIV diagnostic testing should be undertaken at birth, 6 weeks and 12 weeks of age. Evidence from the French perinatal cohort demonstrated that neonatal ART, especially if more than one drug, can delay the detection of both HIV DNA and RNA in the infant [73].