Guidelines

The 2008 British testing guidelines¹ recommend that any infant, child or young person thought to be at significant risk of HIV infection, including all those with parents or siblings who are HIV-infected, should be tested. This is considered to be in the best interests of the child.

Those who should be considered for testing include:

• Infants and children whatever their age, where the mother has HIV, or may have died of an HIV-associated condition.
• Infants born to mothers known to have HIV in pregnancy.
• Infants born to mothers who have refused an HIV test in pregnancy.
• Infants and children who are presented for fostering/adoption where there is any risk of blood-borne infections.
• Infants and children newly arrived in the UK from high-prevalence areas (including unaccompanied minors).
• Infants and children with signs and symptoms consistent with an HIV diagnosis (a list of clinical indicator disease for paediatric HIV infection is provided).
• Infants and children being screened for a congenital immunodeficiency.
• Infants and children in circumstances of post-exposure prophylaxis.
• Infants and children in cases where there has been sexual abuse.

More specific guidelines on testing children who have HIV-positive parents or siblings are given by the Children’s HIV Association.² The guidelines suggest that:

• Any infant at risk of HIV infection must be HIV tested as a matter of urgency – due to the risk of rapid disease progression at this stage.
• For children who are asymptomatic, health care providers should discuss the need to test with the parent or guardian. Parents may be offered sufficient time to come to terms with the prospect of testing their child (six months maximum). If after this time, the parents are still not ready, a further six months period may be granted, but after this the child may need to be referred to social services to safeguard the child’s wellbeing.
• Where a child is hospitalised or is frequently unwell with symptoms suggestive of HIV infection, a more direct approach will need to be taken and consent for testing agreed within a much shorter time scale.