[Leesie4]

I am hoping that someone can help me understand the conflicting information I am hearing about the reliability of the ELISA HIV test in infants. I am currently adopting from Ethiopia. My international agency says that the Elisa test for HIV upon entrance to the orphanage is reliable even for young infants as the likelihood of a false positive is far more prevalent than a false negative. Conversely, my local home study agency says I have every reason to be concerned by the lack of a PCR test before my embassy visit (which is the first opportunity I will have for the administration of this test).
The person I spoke to at the CDC suggested the Elise was accurate though they could not be specific to infants. AidsInfo (.gov) said I should not depend on the ELISA test. Does anyone have experience with this research who could speak to me? A posting or PM would be seriously appreciated as I am freaking out trying to decide what I can/should do. I have seen AIDS in children and I am not equipped to deal with it at this stage in my life. Thanks in advance for your time.

[teranga]

First of all, be aware that never, in any adoption from Ethiopia, has a child tested negative in Ethiopia and positive once in the U.S. So that counts for something right there.

I can't answer the specific test question, but I can tell you I was concerned as well, and that they did an HIV test upon my son's arrival (adopted from Ethiopia) to the orphanage (he was 4 months at the time). They then tested him again once he'd been there about 2-3 months. And then the US Embassy tests the child themselves, as the process of getting a visa for an HIV+ child is very different and much longer than for an HIV- child, so they are making sure they test themselves. At this point, your child has had 3 HIV tests. I was totally comfortable with this level of testing, however, I was advised that upon receiving the referral (but before accepting it) I could pay to have an independent physician in Addis do another HIV test (type of my choosing).

So..I'd ask if your child can be tested twice in the orphanage (as it is true that if they'd just been exposed when tested the first time they might not test positive right away, although for an infant the most likely scenario--by far--is that they would have contracted it at birth and not after). Then have another test done by an independent physician in Addis (your agency should be able to help you find one). And then of course you still have the US embassy test as well.

My dr. here in the US was not at all concerned once he heard about how many tests my son had--and he didn't even ask what kind they were--I think the sheer number of them over several months made him comfortable. I did repeat the test, nonetheless. As expected, negative.

Teranga

[adoptethiopiablog]

This site might be helpful to you
Am I Infected? (A Complete Guide to Testing for HIV)

[adoptethiopiablog]

I blogged about this todayEthiopia Adoption Blog - HIV testing: which test?

[momily]

There are 2 types of tests for HIV. One is tests that look for antibodies, which includes the ELISA test, and the other is tests that look for fragments of the DNA of the HIV virus which includes PCR test.

Any child born to an HIV positive birthmother will test positive for antibodies as an infant, simply because the antibodies always cross the placenta. Those antibodies will gradually disappear, and unless the child starts producing his own antibodies (an indication he's infected) the test result will "convert" to negative. In this country (where most mothers have access to antiviral medication) the "conversion" rate of infants with positive ELISA's is like 98%, in Ethiopia it's lower but the majority still do convert.

However, the only way that the HIV DNA will show up on the PCR test is if the child is in fact infected with the virus -- generally either during the pregnancy, during the birth process or through breastfeeding. The DNA test is reliable a few months after the possible exposure. So, a child exposed during pregnancy may test positive as a newborn, while a child exposed during birh may appear negative at birth and positive at 1 or 2 months old. A negative test result in a 3 month old who has never breastfed, or in an older child who hasn't breastfed in the past 3 months is considered conclusive.


To answer your question as to whether a negative ELISA is enough, I'd guess I'd say that a negative ELISA indicates that the birth mother did not have the virus, which makes it really unlikely that the child is exposed. I guess, it's possible that the child breastfed from someone who was positive and contracted the virus that way (e.g. mom left the child with an aunt who was also nursing and she fed the child?, mom contracted the virus after giving birth but while she was still nursing?), and happened to pass the virus to the child (the transmission rate via nursing is very very low) and that experience was recent enough (within the past few months before the ELISA testing) that the child hadn't developed antibodies yet, but that's the only way I can think of that you'd have a false negative. That seems unlikely to me. In case you're wondering why they would do an ELISA and not a PCR there's a huge cost difference between the two.

If I were in the situation I'm imagining that you're in, (e.g. you've received a referral for a very young child who has a negative ELISA and no PCR), I'd probably ask for the PCR for peace of mind. But if for some reason that wasn't possible, it wouldn't stop me from accepting the referral. Like I said, I think the odds of a child from a negative birthmother having the virus are incredibly low.

Good luck!

[shellydm]

Hi-

Our daughter tested neg to whichever HIV test they do in Guatemala for the child to be allowed home. I don't know the test but it was sufficient for the INS.

After she came home she had a routine Elisa HIV test and it was positive!! They then did a PCR test and it was negative thank Goodness. But it was a VERY long couple of days. Even with the PCR testing neg they still want to retest our daughter after 6 months. (which will be next month). I won't be able to breathe until the PCR is repeated again after the 6 months.

I think they should do the PCR test because it is the diagnostic test. The Elisa is a screening that can give false positives and put a family through emotional hell while waiting for the PCR. Its cheaper to do the Elisa so that is why everyone does it first. I think its cruel to the families because there are more false positives then they like to say and they should do the PCR because it is DIAGNOSTIC!! But what I think unfortunately is not what they do nor insurance agencies pay for. We had to fight for them to pay for the PCR!

Please feel free to PM me if you have any more q's.

Shelly