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[Diagnosis of HIV infection in newborn infants in Europe and in developing countries].

Diagnosis of HIV infection in newborn infants of seropositive mothers is essential to initiation of treatment. The risk of vertical transmission is estimated at around 20% in Europe and the U.S. and 25% in Africa where it is increased by breast feeding. The risk is known to depend on the clinical status of the mother. Virological analyses by the French Cohort Study suggest that around 30% of the infections occur in utero late in pregnancy while 65% occur on the day of delivery. Fetomaternal blood exchanges and maternal secretions in the birth canal are believed to lead to infection. Diagnosis of infants infected in utero may be based on specimens taken at birth but later testing is necessary for infants infected during delivery or breast feeding. The risk of transmission during breast feeding is estimated at 5-7%. The presence of maternal antibodies prevents use of the usual serological tests in newborns. The technique of viral culture which may be applied to any strain of HIV-1 or HIV-2 allows diagnosis of most positive cases within 15 days. The sensitivity of the test increases from 40% at birth to over 95% at 2 months. The polymerase chain reaction (PCR) technique applied to DNA is possibly as sensitive as viral culture. Laboratory trials of PCR applied to RNA have given promising results. The lack of consensus on the criteria for considering a diagnostic result positive is at the origin of observed differences in sensitivity and specificity of methods of PCR and viral culture developed in different laboratories. All positive results should be confirmed on a second independently obtained sample. To diagnose noninfection may require 2 or 3 negative tests after the first week of life. After 18 months the same methods of serodiagnosis utilized in adults may be used. Technical and financial difficulties prevent widespread testing of newborns in many developing countries.