Question

A 2-month old infant born to an HIV- positive mother presents with recurrent diarrhea. What is the next best step?

• A. Test stool for giardia and give antibiotics
• B. Dried spot sample for HIV DNA PCR
• C. Antibody test for HIV
• D. Aerobic culture

Answer 1

The Correct Option is B

In managing an infant born to an HIV-positive mother, it is crucial to determine the child's HIV status, especially considering symptoms like recurrent diarrhea, which could indicate an underlying HIV infection. For this age group, the most definitive and reliable method to diagnose HIV is through a DNA PCR test.

The reasoning for selecting this method is grounded in the limitations of antibody tests at this stage in an infant's life:

1. Infants can retain maternal antibodies for several months, making antibody tests unreliable until around 18 months.
2. DNA PCR can detect the virus itself rather than antibodies, providing a more accurate diagnosis in infants as young as 2 months old.
3. Detecting the virus early allows for prompt initiation of Antiretroviral Therapy (ART), crucial for improving the prognosis and quality of life.

As a result, while other tests such as stool culture and antibody tests may address secondary concerns, the immediate clinical priority for suspected HIV infection warranting ART initiation is confirming the infant's status via a "Dried spot sample for HIV DNA PCR".