To help prevent vertical transmission of human immunodeficiency virus (HIV), infants born to seropositive mothersshould receive zidovudine (ZVT) for the first 6 weeks of life
To help prevent vertical transmission of human immunodeficiency virus (HIV), infants born to seropositive mothersshould receive zidovudine (ZVT) for the first 6 weeks of life: Excerpt from Avoiding Common Pediatric Errors
Author:
Brian Kit, MD
What to Do - Take Action
Epidemiology
Perinatal transmission is the most common source of HIV infection among
infants and children in the United States, accounting for >90% of children
withacquiredimmunodeficiencysyndrome(AIDS)<13years.IntheUnited
States, the number of infants born with HIV in 2001 was between 280 and
370, compared withapproximately1,000to 2,000neonates withHIVborn in
1991.Duringthesameperiod,thenumberofmotherswithHIVintheUnited
Statesalsoincreased.Muchofthesuccessofthedecliningtransmissionrates,
despiterising number ofpregnant women withHIV, istheresultofincreased
HIV screening of pregnant women and the use of antiretroviral drugs for
both mother and baby.
Human Immunodeficiency Virus Testing
in Pregnancy
The American Academy of Pediatrics (AAP) and the American College of
Obstetricians and Gynecologists issued a joint statement supporting universal testing with patient notification as a routine component of prenatal
care. Optimally, results of HIV should be known prior to labor and delivery
to facilitate antepartum and intrapartum treatment. If the mother's HIV
status was not determined during pregnancy,the AAP encourages pediatricians to discuss with the mother benefits of early identification of HIV and
recommends testing at that time.
Medication Strategy to Prevent Perinatal
Transmission of Human Immunodeficiency
Virus
In 1994, the results of Pediatric AIDS Clinical Trials Group (PACTG)
Protocol 076 documented that a three-part zidovudine (ZDV) chemoprophylaxis regimen could reduce the risk of perinatal HIV transmission by
approximately two-thirds. The regimen includes oral ZDV initiated at 14 to
34 weeks' gestation and continued throughout pregnancy, followed by intravenous ZDV during labor and oral administration of ZDV to the infant for
6 weeks after delivery. Oral administration of ZDV to the newborn is dosed
as ZDZ, 2 mg/kg/dose every 6 hours.
Since 1994, several new therapies and treatment approaches for HIV
and AIDS have evolved. Up-to-date information is available through many
sources, including online at http://hivatis.org, which is a service of the U.S.
Department of Health and Human Services. Despite the evolving management strategies, it generally remains true that any prenatal treatment
regimen should include ZDV whenever possible. In addition, regardless of
antepartum treatment, all women should receive intrapartum ZDV and their
newborns should receive a full 6 weeks of ZDV.
Newborn Care
In addition to ZDV for 6 weeks to prevent the transmission of HIV, children should receive Bactrim chemoprophylaxis to prevent the development
of Pneumocystis carinii pneumonia (PCP). PCP is a rapidly progressing and
oftenfatalopportunisticinfectionthatcanbepreventedwithBactrimchemoprophylaxis. The greatest risk for PCP in children with perinatal acquired
HIV occurs between 3 to 6 months of age. Bactrim prophylaxis is discontinued when HIV infection has been reasonably excluded, usually after two
negative virology studies, with one of the tests performed before 4 months
of age.
Human Immunodeficiency Virus
Testing of Human Immunodeficiency
Virus-Exposed Infants
Following recommended HIV screening strategies is important because
HIV-exposed neonates are usually asymptomatic and have normal physical exam findings during the neonatal period. Confusion about the appropriate laboratory evaluation of HIV-exposed neonates among providers can
result in unnecessary costs and emotional burdens to the family. Because
of transplacental transfer of maternal antibodies, tests for antibodies (i.e.,
enzyme-linked immunoabsorbent assay [ELISA] and Western Blot) should
not be used to make a diagnosis of HIV infection in children younger than 18
months of age. Virologic testing (i.e., HIV DNA polymerase chain reaction
[PCR]) should be performed at birth, at 1 to 2 months of age, and at 3 to 4
months of age. A positive result at any point should be immediately repeated
for confirmation. Babies who have three negative virologic tests should undergo antibody testing at 12 months of age. If this test is negative, screening
should be repeated at 18 months of age with an antibody test. A positive
HIV antibody test after 18 months indicates HIV infection. A negative test
indicates no infection.
EarlyscreeningforHIVinpregnantwomenprovidesanopportunityfor
reducing the perinatal transmission of HIV. In the setting of HIV exposure
during pregnancy, the pediatrician can ensure appropriate follow-up testing
withvirologicstudiesandtreatmentwithZDVfor6weeksfortheprevention
oftransmissionofHIV.ProphylaxiswithBactrimtopreventPCPwillreduce
mortality of infants who are born with HIV.
Suggested Readings
American Academy of Pediatrics, American College of Obstetrics and Gynecology. Human
immunodeficiency virus screening. Joint statement of the American Academy of Pediatrics
and the American College of Obstetricians and Gynecologists. Pediatrics. 1999;104(1 Pt 1):
128–135.
Considerations for antiretrovial therapy in the HIV-infected pregnant woman. Available at: http://
www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.section.10362. Accessed June 24, 2007.
U.S. Department of Health and Human Services. AIDSinfo. Available at: http://hivatis.org.
Accessed June 24, 2007.
>
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
More About HIV/AIDS
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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