Presumed severe HIV disease in infants (PSHD)

Clinical description

• Infants infected with HIV develop life-threatening HIV-related disease much more quickly than

older children and adults.

• Conduct point of care DNA-PCR testing on site for timely clinical decision making, if available.
• However, it may take too long to confirm HIV infection in a sick infant using DNA-PCR.
• Under the age of 12 months, a positive HIV rapid antibody test does not confirm HIV infection

because maternal antibodies pass through the placenta and remain in the baby’s blood for several months.

• However, a positive rapid antibody test in an infant with the following clinical signs makes severe

HIV disease (AIDS) very likely:

Table 4: Definition of presumed severe HIV disease (PSHD)

Infant with positive rapid antibody test PLUS:

Combination of 2: OR At least 1:

• Oral thrush • Severe unexplained wasting / malnutrition not

responding to treatment

• Severe pneumonia
• Pneumocystis pneumonia
• Severe sepsis
• Candidiasis of oesophagus, trachea, bronchi or lungs
• Cryptococcal meningitis
• Cerebral Toxoplasmosis (from age 1 month)
• Start ART as quickly as possible for infants with PSHD – do not wait for a DNA-PCR result.
• Collect a DBS sample for DNA-PCR confirmatory testing on the day of starting ART (see section 16.3

on page 78).