1. Pediatric ID Previous presentation by Susan Schuval, MD
Perinatal HIV
Pediatric ID
Previous presentation by Susan Schuval, MD

2. An infant is born to a 30 year old HIV-infected
Case 1
An infant is born to a 30 year old HIV-infected
woman and you are called to evaluate the infant in the Well Baby Nursery
The infant is 4 hours old and doing well after a
normal spontaneous vaginal delivery
Birth weight: 3 kg
Gestational age: 39 weeks

3. QUESTION 1
Which information is most valuable in determining this infant’s risk for perinatal HIV acquisition?
Maternal antiretroviral medications administered during pregnancy
Date of maternal HIV diagnosis
Maternal viral load
Maternal CD4 lymphocyte count

4. QUESTION 1
Which information is most valuable in determining this infant’s risk for perinatal HIV acquisition?
Maternal antiretroviral medications administered during pregnancy
Date of maternal HIV diagnosis
Maternal viral load
Maternal CD4 lymphocyte count

5. QUESTION 1-DISCUSSION
Maternal viral load is the most important factor in determining whether HIV will be transmitted from mother to infant.
Caesarean section is performed routinely for HIV-infected women with viral loads > 1000 copies/mL.
The timing of perinatal HIV transmission is not known but probably occurs intrapartum

7. ADDITIONAL HISTORY
The mother had an undetectable viral load one month prior to delivery and was treated with Reyataz, Norvir, and Sustiva during the 2nd and 3rd trimesters.
Her last CD4 count was 1200.

8. QUESTION 2 What is the best way to test the infant for HIV infection?
A. HIV serology: EIA/Western Blot
B. DNA PCR
C. RNA PCR
D. p24 antigen test

9. QUESTION 2-DISCUSSION
HIV DNA PCR is the most sensitive assay available to test for HIV infection.
HIV-exposed infants followed by the Pediatric ID Clinic are seen at birth, 2 weeks of age, 6 weeks of age, 4 months and 18 months for PCR and serologic testing.

10. HIV Testing of Infants
Infants born to HIV-infected women will routinely test positive for anti-HIV antibodies because these are transmitted from mother to infant.
In the Pediatric ID Clinic, HIV-exposed infants are followed until they “serorevert”and lose the HIV antibodies, usually between months of age.

14. QUESTION 3
Which regimen is most effective in reducing perinatal HIV transmission?
A. Maternal treatment with AZT during labor and delivery only
B. Maternal treatment with AZT during pregnancy only
Neonatal AZT for a 6 week course
All of the above

15. QUESTION 3-DISCUSSION The 3-part regimen of:
Maternal treatment with AZT during 2nd and 3rd trimesters of pregnancy,
Maternal AZT during labor and delivery, and
Neonatal AZT for a 6 week course
Has been shown to reduce perinatal HIV transmission from 24% to 8% (70% reduction).
Mechanism of action of perinatal AZT: unknown
-Lowers viral load (accounts for 17% of observed efficicay)
-pre-exposure prophylaxis of infant (thru transplacental AZT passage)
-post-exposure prophylaxis of infant (thru continued AZT administration to the infant after birth)i

16. EPIDEMIOLOGY Over 90% of pediatric HIV infection
results from perinatal transmission
U.S: HIV+ women give birth annually
2004: 84 HIV+ infants born
Peaked in mid 1990’s: HIV+ infants born
2000:
2202: 236
2004: 84

17.                      
      
                         
                          
         
            
           
    
Home
> Topics > Perinatal Interventions > Overview of Clinical PMTCT Trials
Overview of Clinical Trials on Prevention of Mother-to-Child HIV Transmission
                                                                                                                                                                                                    
November 2003
Lynne M. Mofenson, MD, National Institutes of Health
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Slide 23: Mother to Child HIV Transmission in the U.S. Over Time
                                                                                                                                                
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19. QUESTION 4 How are infants who test HIV-positive treated?
AZT monotherapy
Bactrim alone
Zithromax
Highly active antiretroviral therapy

20. QUESTION 4-DISUSSION
Infants testing HIV DNA PCR-positive are treated with combination antiretroviral therapy (HAART=highly active retroviral therapy) and PCP prophylaxis.