HIV in Infants: Perinatal Transmission and Management

00:01 Let’s switch now to HIV HIV is also on at increasing prevalence in pregnant women in the United States and worldwide.

00:14 Sometimes people feel like HIV is getting less frequent in the United States because we’re doing a better job of providing condoms.

00:21 But remember, the patients with HIV now are getting excellent care in the U.S.

00:26 and they aren’t dying and they may go on to get pregnant.

00:29 So actually, the rates in pregnant women are going up.

00:33 Thus, transmission rates are important to keep track off.

00:38 A patient is more likely to acquire transmission of HIV in utero if the mother’s viral load is high.

00:47 On average, if the mother is not aware of her disease or is not treated, which is one in four HIV positive Americans.

00:57 A quarter of those babies will go on to acquire HIV.

01:01 However, if we find out the mother is positive just at the time of delivery, we can intervene with the baby and provide HIV medications and reduce that transmission rate to 6%.

01:14 And if we’re aware of mom’s status while she’s pregnant, we can drop that all the way down to less than 2%.

01:21 So undiagnosed babies with HIV really don’t need to occur if we’re routinely screening pregnant women, but it does happen.

01:32 And undiagnosed babies usually present a little bit later on in life with opportunistic infections or failure to thrive.

01:40 So all women need to be routinely tested during pregnancy, all of them.

01:46 Rich or poor or black or white, it doesn’t matter.

01:50 We need to test every one for HIV.

01:53 Routine screening of infants at birth for mothers who are not tested, further prevents infection in two ways.

02:02 First, it dramatically raises the rate at which women get tested and it then catches those babies who are missed and reduces their risk of infection from 25% to 6%.

02:14 And rapid testing is effective in infants.

02:18 So we can check real quick.

02:21 If a mother is exposed, we should test the infant with quantitative PCR at regular intervals to wait and see if this child turns positive.

02:31 Remember that even if the baby doesn’t have HIV and the mother does, that baby may have a positive antibody test as long as 18 months after delivery because mom’s antibodies can persist in the baby because of transplacental spreads for a long period of time.

02:51 How do we treat babies? We give them HAART therapy.

02:55 We do that for confirmed, infected infants.

02:58 During delivery, we will give mothers AZT and that can reduce transmission.

03:04 Also, if a mother is known to have a high viral load, we may proceed directly to C-section to reduce risk to the infant.

03:12 Exposed infants will get AZT orally for six weeks after birth.

03:18 And infants will get trimethoprim sulfamethoxazole prophylaxis until the HIV status is known to be negative.