Grand Rounds


Medical Sciences Department, Pediatric Oncall, Mumbai, India

Clinical Problem :
A 7 years old boy born to a commercial sex worker was referred by an orphanage for HIV testing. Both parents had abandoned the child and the child was living in the orphanage for the past 2 years. His HIV ELISA at time of admission to the orphanage was negative. Currently the child was on antituberculous treatment for past 3 months in view of primary complex with mantoux positive. His HIV ELISA now was positive. On retesting, it was again positive. He had never received any blood products.

How did this child’s HIV ELISA change from negative to positive_?

Discussion :
There are several explanations for the same:
1. First HIV ELISA report was wrong. This is possible since the child was born to a commercial sex worker. It is quite likely that the mother may have had HIV infection and the child may have acquired the infection vertically and was HIV infected. However, the child has had no opportunistic infections in past or other HIV related illnesses apart from tuberculosis which is anyway endemic in the country.
2. Sexual abuse since the child was HIV negative at the time of admission in the orphanage, it is likely that the there may have been sexual abuse leading to HIV infection. However, it can only be an assumption and it may not be possible to prove the same.

To prove that the report was wrong, one needs to do a confirmatory test which should be a Western blot test. In this child, the western blot test was positive.

There are instances where transmission of HIV in a child may be unknown and one would need to always rule out sexual abuse as an underlying cause.

Correct Answers :  yes 65%
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