HIV

HIV can be transmitted vertically during pregnancy, birth or breastfeeding.

Prevention of Transmission During Birth

The mother’s viral load determines the mode of delivery:

• Normal vaginal if < 50 copies/ml

• C-section if > 50 copies/ml

If the baby is at risk, antiretroviral prophylaxis is given:

• Low risk babies (mother < 50 copies/ml) – Zidovudine for 4 weeks

• High risk babies (mother > 50 copies/ml) – Zidovudine, Lamivudine + Nevirapine for 4 weeks

Testing

After the mother can delivered, the baby should be tested for HIV:

• HIV Viral load at 3 months – If -ve, baby hasn’t contracted HIV during birth

• HIV Ab test at 24 months – Check to see if they’ve contracted HIV since their 3 month viral load test e.g. through breastfeeding

It's important to remember that the Ab test can be falsely positive during the first year due to the maternal Ab’s that have crossed the placenta.

Testing should also be done when:

• Immunodeficiency suspected e.g. unusual/severe/frequent infections

• Young and sexually active

• Risk factors present – Sexual abuse is a major one to consider if suspected

Management

• ART – Aim for normal CD4 and undetectable viral load

• Vaccinations – Avoid live vaccines if severely immunocompromised

• Prophylactic Co-trimoxazole in children with low CD4 to protect against PCP