Updates to the Pediatric HIV Testing Service (as of 1/11/2023)
We are making changes to the Pediatric HIV Testing Service to enhance our ability to detect small amounts of HIV RNA in pediatric samples and improve the efficiency and security of requesting tests and obtaining results.
Specifically, we have introduced (1) new requirements for sample collection and shipment, (2) an additional sample collection timepoint for high-risk babies, and (3) a secure electronic method to request tests and retrieve test results.
The Bloodborne Viruses Laboratory provides pediatric HIV testing to definitively diagnose HIV infection in infants who are born to people living with HIV. To diagnose HIV infection in this age group, HIV DNA or RNA must be detected using a nucleic acid test (NAT). Antibody-based tests cannot be used because maternal HIV antibodies are transferred to the infant and can persist for up to 18 months.
HIV infection can be excluded in HIV-exposed infants after they have two negative NAT results, one when they are at least one month old and another when they are at least four months old. HIV infection is confirmed when there are two positive NAT results performed on separate specimens collected at any age. Tests Include:
HIV-1 RNA testing: The Bloodborne Viruses Laboratory uses the Aptima HIV-1 Quant Dx assay to perform qualitative HIV-1 RNA detection in plasma or serum specimens collected from HIV-1 exposed infants. This assay is FDA-approved for use as an aid in the diagnosis of HIV-1 infection. Results of this test are reported as Detected or Not detected. The manufacturer’s recommended specimen is 0.7 mL of plasma or serum. The Bloodborne Viruses Laboratory has approval from the NYSDOH Clinical Laboratory Evaluation Program to perform this test on infants using smaller volumes of plasma; however, testing the recommended volume is preferred for optimal sensitivity.
HIV-2 Nucleic Acid Testing: The Bloodborne Viruses Laboratory uses a lab-developed, real-time PCR assay to detect HIV-2 RNA in HIV-2 exposed infants.
Recommendations on Timing of Testing
Two to five specimens per infant may be necessary to determine the infant's HIV infection status. Any infant, regardless of age, with a positive NAT result should have another blood specimen collected for testing as soon as possible to confirm the positive result. No further testing is needed for diagnosis after the second positive result. In accordance with NYS clinical guidelines, our laboratory requests specimens to be collected at the following times from HIV exposed infants:
- within 48 hours after birth
- 2 weeks of age
- 4 to 6 weeks of age
- 8 to 12 weeks of age (for infants at greatest risk for perinatal HIV infection)
- 4 to 6 months of age
Note: Negative NAT results in an infant younger than 28 days do not exclude HIV infection, particularly if the infant has been exposed to antiviral medication in utero or after birth.
How to Submit Specimens for Pediatric HIV Testing
- Obtain a Pediatric HIV test kit by calling the Order Desk (518) 474-4175
- Follow collection guidelines for pediatric HIV testing
- Complete the Infectious Disease Requisition (DOH-4463) form
- The preferred method is to request pediatric HIV testing online via the Health Commerce System.
- The alternative method is to click on the link above to download a fillable PDF version of the form. Complete all required fields, including fields designated as ‘Required for HIV Testing of Infants’ in the Clinical and Exposure History Section.
- Ship specimens using shipping label enclosed in Pediatric HIV test kit
- For full details please see Collection, Shipping and Reporting