Preventing perinatal transmission of HIV: Your vigilance can pay off

The Journal of Family Practice. 2010 March;59(3):E1-E6

March 1, 2010|The Journal of Family Practice

These interventions can keep the risk of mother-to-child transmission at less than 2%.

TABLE 2
Follow-up measures for infants exposed to maternal HIV^1,27

ZDV prophylaxis From birth to age 6 weeks
Diagnosis of HIV Virologic test (required for infants <18 months of age; HIV DNA PCR preferred) At birth (optional), 14 to 21 days, 1 to 2 months, 4 to 6 months If positive, repeat immediately on a separate specimen for confirmation; 2 positive HIV DNA PCR tests confirm a diagnosis of HIV infection HIV presumptively excluded (nonbreastfed infant): 2 or more negative tests, with 1 at ≥14 days and another at ≥1 month. HIV definitively excluded (nonbreastfed infant): 2 negative tests at ≥1 month and ≥4 months of age.
HIV ELISA 18 months. Confirmatory test if HIV DNA PCR tests performed as above are negative
Complete blood count At birth, when initiating ZDV prophylaxis, and at time of 1st HIV DNA PCR (2-3 weeks)
*Prophylaxis against Pneumocystis* pneumonia** Trimethoprim-sulfamethoxazole beginning at 6 weeks, with discontinuation of ZDV prophylaxis, unless HIV presumptively excluded (see above)
Routine Immunizations As per general US pediatric immunization schedule
DNA, deoxyribose nucleic acid; ELISA, enzyme-linked immunosorbent assay; HIV, human immunodeficiency virus; PCR, polymerase chain reaction; ZDV, zidovudine.

CORRESPONDENCE
Michael A. Tolle, MD, Baylor College of Medicine, 6701 Fannin Street, CC1210, Houston, TX 77030; tolle@bcm.edu

Acknowledgements
The author thanks Heidi Schwarzwald, MD, Gordon Schutze, MD, and Mark Kline, MD, for their comments on this manuscript.