Policy for HIV and Hepatitis C Testing of Adopted
Infants
Although HIV infection rates are falling in the United States, Hepatitis C rates are
burgeoning in the drug and alcohol using populations. Testing and evaluation of newborns is
very complex, complicated by the fact that Hepatitis C is a relatively new phenomenon and
there is no long-term experience with children infected with Hepatitis C. The following
guidelines are recommended for all adopted children, especially infants:
All infants should have Hepatitis C and HIV screen at birth or as soon thereafter
as possible. When a child less than one year old is first seen, if testing results cannot
be documented, we recommend testing. If we are seeing a child older than one year, decision
to test will be a clinical decision left to the pediatrician, but we recommend testing. If
the child is adopted from overseas, all screening should be repeated no matter what the
results reported from overseas.
If the initial antibody is negative, it is highly unlikely that this is a false
negative* for either Hepatitis C or HIV. No repeat antibody screen is needed, although
parents may wish to have one done if the child was less than 6 weeks of age at the time of
testing. In this case, a repeat antibody screen can be done at two months of age.
If the initial antibody is positive, a PCR needs to be done.
HIV: A PCR in the first three months has about a 40% chance of being a false
negative. PCR for HIV infection reaches almost 100% accuracy by 4 months. If the PCR is
negative for HIV at 4 months, no further evaluation is needed. If the parents wish to
follow up with a confirmatory PCR, this should be done at six months.
Hepatitis C: A PCR at 6 weeks to two months of age has about a 20% chance of being
a false negative. The accuracy slowly increases, so that by 6 months, chances for a false
negative are 10%. Many experts recommend that a PCR not even be done until 6 months of age.
However, this is untenable for many families trying to make a decision around adoption. A
reasonable course would be to perform a PCR at 6 weeks to two months. If it is positive,
that gives the family significant information, although it still is not 100% accurate. If
negative, it narrows the statistical chances for the family down to a 20% chance. Since
overall likelihood of transmission of Hepatitis C is about 5% from mother to child,
statistically the baby probably is not infected. This information regarding Hepatitis C
relates to the child who is HIV negative. If the child is HIV positive, transmission of
Hepatitis C is many times higher, so the protocol for testing would be different.
*A false negative is a blood test that is negative, but the baby actually is infected.
