If a mother is HIV-positive and the children so far test negative, can they be carriers? Could they ever end up testing positive? The mother is a drug addict.

Shari

I use the term "carrier" to describe a person with an infection or other disease with no signs or symptoms whatsoever. For example, some people with chronic hepatitis B infection have no liver damage whatsoever. They can pass the virus on to others, but they themselves are not ill. Typhoid Mary was a carrier of the typhoid bacterium, infecting hundreds of people without being ill at all. After infection with HIV (the virus that causes AIDS), most people remain carriers for years until they finally develop symptoms or signs of the disease. Still, during this asymptomatic (symptomless) stage, the various tests for HIV will be positive.

Babies born to HIV-infected mothers pose a difficult diagnostic challenge. Standard HIV tests detect antibodies directed against HIV. However, during pregnancy, a mother with HIV can pass her own anti-HIV antibodies to the fetus. When this happens and the newborn is tested, some of these antibody tests can be positive. Other tests (such as PCR) that detect the virus itself are needed to confirm that transmission has actually occurred in these infants. If these tests are negative, then it is very unlikely that the newborn indeed has HIV. If these extremely accurate tests are positive, however, then the newborns are almost certainly carriers of the virus.

If these children are not infected at birth but still under the care of their HIV-infected mother, then they are at some risk. If the mother injects drugs, the children may come in contact with infected blood or drug paraphernalia. In addition, breastfeeding can transmit HIV. Because of this, most authorities recommend that in the United States, such babies be bottlefed. (In underdeveloped countries, however, the benefits of breastfeeding actually may still outweigh the risks associated with it.) Aside from these concerns, there is not that much to worry about. Household transmission of HIV is uncommon. I would counsel the mother to not allow the children to come into contact with her blood or other fluids that could be contaminated with blood. To further minimize the possibility of transmission, I also would recommend that she cover all wounds or sores that she or her children have.