perinatal AIDS

Transmission

Transmission of HIV to infants occurs in utero, during labor and delivery, and through breastfeeding. Approx. 50% to 70% of infants are infected during childbirth, esp. during preterm birth with prolonged rupture of membranes; 30% to 50% are infected in utero; 20% of HIV-positive mothers can transmit the infection through breastfeeding.

Diagnosis

The diagnosis is made through two positive blood test results for the presence of HIV or the growth of HIV in culture. Transmission is unlikely to occur in women whose viral load of HIV RNA has been reduced by effective antiretroviral therapy. The Centers for Disease Control and Prevention (CDC) recommends that all adults, ages 13-64 years, should be offered routine HIV testing (with the choice to opt out), rather than testing only those patients with known risk factors for the disease.

Symptoms

Infants may be asymptomatic even when infected with HIV. Infection is monitored by measuring the absolute CD4+ T-cell count, measuring the amount of virus in the blood (viral load), and assessing for the presence of opportunistic infections in infancy or early childhood. Over time, the infected infant may present with Pneumocystis carinii (P. jiroveci) pneumonia, chronic diarrhea, recurrent bacterial infections, failure to thrive, developmental delays, and recurrent Candida and herpes simplex infections. The majority of perinatally infected children develop an AIDS-defining illness by the age of 4. Anemia and neutropenia may occur as side effects of drug therapy.

Treatment

Zidovudine (AZT) is given for 6 weeks to all infants born of HIV-positive mothers. Prophylaxis for P. carinii (P. jiroveci) pneumonia with trimethoprim-sulfamethoxazole begins at 6 weeks and continues for 6 months in children whose HIV test results are negative and for 1 year in infected infants. The use of highly active highly active antiretroviral therapy (HAART) is being studied. Breastfeeding is contraindicated for all HIV-infected mothers to minimize the risk of transmission of the virus.

Patient care

Women in their childbearing years who engage in high-risk behavior and women whose husbands or primary sexual partner may engage in high risk behavior should be counseled to be tested for HIV before becoming pregnant or as soon as they know they are pregnant in order to reduce the risk of infection the baby. Women who are HIV-positive should begin antiretroviral therapy immediately. Standard precautions are used with babies born of HIV-positive mothers until diagnostic tests indicate that they are not infected. Mothers and other care providers must be instructed in the use of these precautions and to watch for and quickly report respiratory infections.