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Caring for Neonates with Perinatal HIV Exposure
Transcript
Perinatal HIV Exposure
Overview
BB James Smith
The Case
38 week AGA male born to a 29 yo G1P1 mother who is known to be HIV+
- What pieces of information do you need to know?
- What labs do you want for baby?
- Does this baby require treatment, and if so what kind?
What maternal history do you need?
History
- Timing of mother's diagnosis?
- Was mother on antiviral treatment during pregnancy? Compliant?
- Other known STIs?
Birth History?
Birth Hx
- Gestational Age?
- ROM timing?
- C-section vs Vaginal?
- Planned CS @ 38wks
- Medications given prior to birth?
- ZDV 3hrs prior
Maternal labs
- Maternal HIV viral load
- Maternal CD4+ count
- Other infectious labs (RPR/TPAB, G/C, Hep B & C, GBS, Rubella)
Labs
Viral Suppression
- Viral suppression is defined as <50 RNA copies/mL in maternal serum
- The most important factor in mother-to-infant transmission
Why?
Newborn Labs
Newborn
- CBC w/ diff
- HIV DNA/RNA PCR
- Urine CMV shell-vial and Culture
- RPR and TPAB
- Maternal Abs can remain in children up to 18 months of age
Treatment Overview
Treatment
- All newborns with perinatal or unknown exposure need to be treated
- Most experts encourage starting ASAP post-delivery
- Treatment is a spectrum based on risk of transmission, stratified into 3 categories
Low Risk Exposure
Prophylaxis
- Mothers who received ART during pregnancy
- Sustained viral suppression near delivery no concerns related to adherence
- Zidovudine for 4 weeks
Presumptive Treatment
High Risk
- Mothers who received neither antepartum nor/only intrapartum ARV drugs
- Treated mothers who have detectable viral loads near delivery, particularly vaginal delivery
- Mothers w/ acute or primary HIV infection during pregnancy or breastfeeding
- Mothers w/ unconfirmed HIV status who have at least one positive HIV test at delivery or postpartum
- Newborns with positive HIV antibody test
HIV Infection
- Positive HIV DNA/RNA test
- Similar regimen as Presumptive therapy w/ extended duration
Proven
Triple Therapy
Regimen
Labs
Follow up
- Monitoring for antiviral side effects
- CBC, bilirubin
- Repeat confirmatory HIV DNA/RNA
- 14-21 days of life
- 1-2 months of life
- 4-6 months of life
- 2-6 weeks post DC ART for high risk exposures
Ruled Out
Exclude
Considered HIV negative when:
- 2 or more negative DNA/RNA PCRs
- one test >/= 1 month age
- second test >/= 4 months ag
- 2 negative HIV Ab tests obtained >/= 6 months of age
- Some also obtain HIV Ab test after 24 months to confirm loss of maternal Abs (previously Ab +)
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