WHO RECOMMENDATION IS as :
"" The Committee recognizes the difficulty in identifying infants infected with HIV at birth in settings where diagnostic and treatment services for mothers and infants are limited. In such situations, BCG vaccination should continue to be given at birth to all infants regardless of HIV exposure, especially considering the high endemicity of tuberculosis in populations with high HIV prevalence. Close follow up of infants known to be born to HIV-infected mothers and who received BCG at birth is recommended in order to provide early identification and treatment of any BCG-related complication. In settings with adequate HIV services that could allow for early identification and administration of antiretroviral therapy to HIV-infected children, consideration should be given to delaying BCG vaccination in infants born to mothers known to be infected with HIV until these infants are confirmed to be HIV negative.""
what is a practical clinical approach in such cases?? advice to mothers....
In South Africa we follow the above. All babies receive BCG at birth as per national immunization schedule unless they are born premature or ill when it is given before discharge from hospital. All mothers are screened routinely for HIV (2x during pregnancy and at birth if not tested before). If the mom is found to be positive - PMTCT is started for mom and baby once born and is very effective in preventing infection. If any direct contact with TB patients in the home the baby is started on INH prophylaxis. This may differ in areas of the world with low HIV/TB incidence and the BCG can then be safely delayed.
ELISA can be false positive in babies up to 18months due to mom's IgG crossing the placenta. If the mom is HIV + we do a PCR at birth and again at six weeks to confirm HIV status. Another final test is done six weeks after stopping breast feeding. The PCR will probably be replaced by P24 antigen or a another test with shorter window period in the near future. In low income settings exclusive breast feeding is advised for 6 months and then completely stopped as long as mom is on ARV, as the risk of malnutrition is weighed against the risk of HIV infection with an undetectable viral load. Mixed feeding is discouraged due to higher risk of HIV transmission through the gut.
PCR at birth and after 6 weeks
That's if mother has been confirmed positive during birth
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