The Department of Health and Human Services' Perinatal Guidelines discuss neonatal treatment. They recommend Zidovudine (AZT) for all newborns with HIV exposure and additional antiretroviral medications for infants considered at high-risk for perinatal transmission. The Illinois Perinatal HIV Hotline's Best Practices: Labor & Delivery Care for Pregnant People with HIV and Care of Infants with Perinatal Exposure to HIV contains detailed information about treatment regimens for both low and high-risk infants. Parents and caregivers who will be responsible for giving medications to the newborn should be educated on the appropriate dosing and administration of all neonatal antiretroviral medications prior to discharge from the hospital. Close follow-up is also necessary to reinforce dosing protocols and to monitor medical compliance.
FAQs
Enhanced case management is provided to people living with HIV who are pregnant, recently delivered, or people with a preliminary positive rapid HIV test at labor and delivery.
Routine HIV testing during prenatal care is an effective way to achieve timely identification of HIV in pregnant people. The Hotline can assist you in referring your patient to a provider in your area specialized in the care of pregnant people living with HIV as well as link your patient to a safety net of services. The Hotline maintains a comprehensive directory of medical and social service resources for every county in Illinois.
The antiretroviral medications Nevirapine (Viramune) and 3TC (Lamivudine) should be considered for infants at increased risk for infection such as those born to people with a high viral load at the time of delivery or who are diagnosed with HIV at the time of delivery. Also, if the birthing parent did not receive antepartum antiretroviral therapy or their HIV virus is known or suspected to be resistant to AZT, the addition of Nevirapine and 3TC to the newborn should be considered. The decision to dose Nevirapine/3TC is made on a case-by-case basis. Please call the Illinois Perinatal HIV Hotline at 1-800-439-4079 to consult on an individual case and see the Hotline's Best Practices: Labor & Delivery Care for Pregnant People with HIV and Care of Infants with Perinatal Exposure to HIV for detailed information on criteria for determining risk status and corresponding recommendations for antiretrovirals.
High-risk patients often fall through the cracks in the medical system and fail to receive necessary treatment and care. For this purpose, the Hotline collaborates with the Mother and Child Alliance's perinatal enhanced case management program. The enhanced case manager can link the patient to HIV/OB care, provide transportation and/or escort to medical appointments, and assist with any and all other social service needs.
The Hotline serves all of Illinois. The Hotline can assist with linkage to HIV/OB care and social services for pregnant people living with HIV and newborns no matter where they live in the state.
By calling the Illinois Perinatal HIV Hotline you can request linkage with perinatal enhanced case management. You will be faxed (or you can print from this site) a release of information form that the client must sign in order to be contacted by the case manager.
There have been many advances in the prevention of perinatal HIV transmission. Without any treatment, the risk of transmission is one in four, about 25% chance. Luckily, there are steps that can be taken to reduce the risk to less than 1%
- Prenatal care (attending all visits)
- Infectious Disease care (attending all visits)
- Antiretroviral medications taken on schedule during pregnancy to achieve an undetectable viral load
- Intravenous AZT during delivery
- Oral AZT syrup (and if needed other antiretroviral medications) to the baby for four or six weeks after birth depending on the regimen
- Formula feeding (Breastfeeding should be avoided as this significantly increases the risk of transmission through the breast milk.)
- Early infant bath, immediately after birth
- Pediatric infectious disease experts or other pediatricians specializing in HIV infection in children should monitor the newborn for at least the first 4 months.
Enhanced case management is designed specifically for people with extra needs. It is a field-based service intended for people who have difficulty linking or staying linked to care.
HIV is diagnosed in adults through antibody or combination antigen/antibody screening tests. However, we do not use this test in infants due to the presence of the birth parent's antibodies in the infant's blood. A DNA PCR (polymerase chain reaction) test is used to detect particles of the virus in the baby’s blood. These tests are usually performed at different intervals, generally recommended at birth, two weeks, two months and 4 months. However, different institutions have other testing schedules. The guidelines indicate that two negative PCR test results are needed to confirm a baby as non-infected with HIV (one before and one after 4 months). Antibody testing is conducted on infants between 12 and 18 months to document the clearance of the birth parent's antibodies. If you are unsure about the best schedule for testing, please call the Illinois Perinatal HIV Hotline at 1-800-439-4079.
