HIV in Infants: Perinatal Transmission and Management

by Brian Alverson, MD

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    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.

    About the Lecture

    The lecture HIV in Infants: Perinatal Transmission and Management by Brian Alverson, MD is from the course Neonatology (Newborn Medicine). It contains the following chapters:

    • HIV
    • Rubella
    • Congenital CMV

    Included Quiz Questions

    1. Routine maternal testing during pregnancy.
    2. Routine C-section delivery.
    3. Withhold HAART therapy until delivery.
    4. Bactrim prophylaxis during pregnancy.
    5. Testing the baby at birth and treat if positive within 6 hours of birth.

    Author of lecture HIV in Infants: Perinatal Transmission and Management

     Brian Alverson, MD

    Brian Alverson, MD

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    Excellent lecture
    By Jalil Z. on 22. August 2020 for HIV in Infants: Perinatal Transmission and Management

    Excellent lecture as usual: easy to understand, easy to remember.