107 Is Early Diagnosis of HIV Infection Feasible in Resource-Limited Settings? Christine Rouzioux*1, F Rouet2, D Ekouevi2, M Burgard1, M Chaix1, and F Dabis3 1Ctr Hosp Univ Necker, Univ Paris V, France; 2CEDRES, Ctr Univ Hosp Treichville, Abidjan, Cote d'Ivoire; and 3INSERM U593, Univ Victor Segalen, Bordeaux, France

Background: The majority of HIV-infected children are living in sub-Saharan Africa. More than 50% of infants infected at birth or through breastfeeding will die before the age of two years in the absence of ARV treatment. Thus, early confirmation of pediatric HIV infection is essential to be in a position to initiate ARV treatment. Due to the presence of maternal antibodies, the serological tests are not useful in the first 9-12 months of life. The prolonged exposure through breastfeeding of the majority of African newborns increases the complexity of HIV diagnosis. Only the direct detection of the virus or viral particles allows the early diagnosis of pediatric HIV infection.

Methods: The review of recent research protocols of Prevention of Mother-To-Child Transmission (PMTCT) conducted in different parts of Africa or Thailand indicates that the detection by PCR of HIV RNA in blood plasma or HIV DNA in blood cells are the reference tests for HIV diagnosis in children, with an equal sensitivity and specificity for both markers. Alternative methods to molecular biology techniques have been also proposed (e.g. p24 antigenemia) but the cost/efficiency ratio of the different methods has not yet been fully evaluated. Moreover, HIV-1 genetic diversity of African strains is one of the major obstacles to the development of a universal tool able to detect all clades and circulating-recombinant forms of HIV-1, particularly those already circulating in sub-Saharan Africa (e.g. in Cameroon, Congo or Burkina Faso). In the context of clinical research programs conducted by the French Agency for AIDS Research (ANRS), PMTCT studies have been conducted in Abidjan, Côte d’Ivoire, and included the implementation of a new low cost molecular technique based on real time PCR,

Results:  After two years of large-scale use of this new technology in the field, our results show that HIV diagnosis in children is simple and reliable in comparison to commercial kits, and at least as feasible, even under difficult circumstances. One of the main concerns is the feasibility of molecular techniques in laboratories with restricted conditions, although organizing the transfer of dried blood spots to a central laboratory with equipment and trained technicians has been demonstrated to be feasible.

Conclusion Access to treatment for HIV-infected children is one of the most important challenges for the next two years,. Thus, early HIV diagnosis in children is one of the first critical issues which needs implementation within the health infrastructures.