Recommendations for the medical evaluation of children prior to adoption in South Africa

Loss of detectability and indeterminate results: Challenges facing HIV infant diagnosis in South Africa’s expanding ART programme

“…Although SA has approximately 3.8 million orphans [15] and the current legislative framework supports adoption as the preferred form of alternative care, no national guidelines regarding the appropriate medical evaluation of children prior to adoption have yet been developed. [16] Similar difficulties to those in case 1 can be experienced when trying to confirm HIV status in infants already initiated on cART where the results of baseline testing are either uncertain or not available. The second case highlights the difficulties of confirmatory testing in the context of 'fast-track' entry into the treatment programme.…”

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“…Furthermore, children already initiated on combination ART (cART) may be retested with HIV-1 PCR assays for 'confirmatory' purposes, including assessment prior to adoption. [8] The potential for cART to compromise the sensitivity of HIV-1 PCR assays has been described, but appears to be under-appreciated both by clinicians and the lay public. Similarly, current PMTCT practices may lead to repeatedly indeterminate results, probably because ART suppresses the HIV viral load below diagnostic threshold values, with subsequent delays in initiation of cART.…”