HIV exposure and infants–evaluating and managing Flashcards
Why is it critical to make the diagnosis and start treatment in an infant exposed to HIV?
And HIV infection is life-threatening for an infant so establishing the diagnosis is crucial
What type of test needs to be ordered for testing an infant suspected of having HIV,?
Nucleic acid testing is essential because of the transplacental passage of maternal HIV antibodies
What should infants born to HIV-positive mothers receive after delivery?
Postexposure prophylaxis
For HIV-positive mother who have received treatment what is the exposure risk for their babies?
Low risk
What is a low viral load in HIV infected mothers?
Less than 50 copies per mL
For infants at low risk for vertical transmission of HIV how often should they be tested?
They should be tested 4 times after initial test, nucleic acid for HIV at birth, then 14-21 days, then 1-2 months of age, then 2-3 months of age, and then 4-6 months of age. Confirmation is with a repeat nucleic acid test.
What risk level are infants born to HIV-positive mothers with unknown or high viral load?
Increased risk and possibly at high risk if there is lack of prenatal care, maternal treatment started late in pregnancy, insufficient maternal treatment to suppress viral load, or detectable viral loads greater than 50 copies per mL.
What is the recommended testing schedule for infants delivered to HIV-positive mothers with an unknown or high viral load?
Nucleic acid testing at birth, 14-21 days, then 1-2 months, then 2-3 months, and then 4-6 months of age. Positive tests are confirmed by repeat nucleic acid testing.
Which should be done in the rare instance of a mother with unknown HIV status?
The mother or the infant should have HIV antibody testing ASAP when the mother presents in labor. Results reflect the mother status.
How does nucleic acid testing work.
HIV DNA PCR is a qualitative test that detects pro viral HIV DNA in the peripheral blood mononuclear cells.
What is the limitation of nucleic acid testing for HIV?
He it is not very sensitive with recent infections. Sensitivity increases after several weeks.
Discussed nucleic acid testing with HIV RNA testing?
HIV RNA can be either qualitative or quantitative. These tests are better at detecting infection at birth. However if the infant and her mother have been treated with antivirals there is a risk for false negative results.
How soon should infants be treated who are delivered to HIV-positive mothers?
Prophylaxis should be started within the first 6 to 12 hours of life.
For infants at low risk of vertical transmission what is the post exposure prophylaxis regimen?
Zidovudine for 4 weeks
What is the treatment regimen for infants born to high risk for HIV verticle transmission?
Combination prophylaxis indefinitely with zidovudine, lamivudine, and either nevirapine or raltigravir.
