Neonatology/Pediatrics and HIV FAQ
By screening early for HIV and again in the third trimester, pregnant women can receive medications that greatly reduce the risk of HIV transmission from mother to child. In Illinois, when women deliver without a documented HIV status, the state requires that the newborn be tested for HIV as soon as medically possible. This fact sheet highlights questions pediatricians might have about the rapid test and the transmission of HIV from a woman to her newborn.
Risk of Perinatal Transmission of HIV
Q: Are all babies born of HIV positive women automatically infected with the HIV virus?
A:
There have been many advances in the prevention of HIV transmission from mother to child. 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 2%
- Prenatal care (attending all visits)
- Infectious Disease care (attending all visits)
- Antiretroviral medications that include AZT taken on schedule during pregnancy to achieve an undetectable viral load
Note: Some women may not be placed on AZT due to previous resistance -the infectious disease specialist will consult with the obstetrician.
- 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 breastmilk.)
- 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.
Remember that the woman must also continue her HIV care after delivery. Every baby needs a mother that stays healthy!
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Q: Is there a risk for transmission if the woman is HIV negative and the partner is HIV positive?
A:
If a woman is HIV negative and her partner is HIV positive, there is no risk of perinatal transmission to the baby. However, pregnant women are STILL AT RISK for acquiring HIV infection and condoms must be used every time the couple has intercourse to prevent transmission of HIV to the mother while pregnant. A woman who becomes HIV positive while pregnant has a greater chance of transmitting the virus to her baby. Women in this and all high risk situations should be retested for HIV during the third trimester.
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Rapid HIV Testing for Newborns with Unknown Maternal Status
Q: What are the concerns for pediatricians if the mother’s HIV status is unknown (i.e. was not tested or the mother refused the test?)
A:
Although HIV status is known in the majority of pregnant women or a rapid HIV test is done during delivery, in a small number of newborns the mother’s HIV status may not be known. In these situations, it is critical to do a rapid HIV test on the newborn as soon as possible after birth, since early prophylactic therapy for newborns of HIV positive mothers can still prevent infection in almost half of infants.
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Q: What is the law in Illinois regarding rapid HIV testing of newborns?
A:
In Illinois, when women deliver without a documented HIV status, the state requires that the newborn be tested for HIV as soon as medically possible. This testing is mandated by law in the Perinatal HIV Prevention Act.
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Care of HIV-Exposed Infants
Q: What are the concerns for pediatricians caring for babies that are rapid tested preliminary HIV positive at delivery?
A:
The rapid test is quite accurate in diagnosing possible HIV exposure in the infant. The infant should be treated with a weight-appropriate dose of AZT as soon as possible. That dose should be repeated according to the hospital policy for treatment of HIV-exposed newborns until a confirmatory Western blot result is available. Click here for the Illinois Perinatal HIV Hotline’s neonatal treatment guidelines. There is no need for an EIA (Elisa Immunoassay) test; send the blood for a Western blot confirmation ONLY.
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Q: When is it recommended to give the newborn a dose of Nevirapine?
A:
There is not a set protocol for administration of Nevirapine to the newborn. A one-time dose of Nevirapine may be considered for infants born to women with a high viral load at the time of delivery or who are identified as HIV positive at the time of delivery. Also, if the mother’s HIV virus is known or suspected to be resistant to AZT, addition of Nevirapine to the newborn should be considered. The decision to dose Nevirapine 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.
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Diagnosis of HIV in Infants
Q: How is HIV diagnosed in an infant?
A:
Typically, there is no need for antibody testing of an infant at birth if the HIV test was done on the mother during the pregnancy. HIV is diagnosed in adults through antibody screening tests, confirmed by Western blot. We do not use this test in infants due to maternal antibodies. 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, sometimes recommended at birth, two (2) weeks, and sometimes monthly until after four (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 maternal antibodies. If you are unsure about the best schedule for testing, please call the Illinois Perinatal HIV Hotline at 1-800-439-4079.
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Linkage to Care
Q: How can I link a woman or infant to an HIV case manager, social worker or medical care?
A:
You can call the Illinois Perinatal HIV Hotline at 1-800-439-4079 to link a woman with medical care and social services (food, housing, transportation, support groups, benefits, respite care and referrals) in her area.
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Q: Why is it important to link HIV-exposed newborns and their mothers with social services?
A:
Many women find out about their HIV status through prenatal testing. HIV and pregnancy can be very isolating therefore it is important to stress to the patient that she is not alone. Many people become overwhelmed and experience depression when they are first diagnosed. We recommend that you refer patients to a social worker or case manager who specializes in caring for people with HIV. There are many government-sponsored programs for people with HIV who have limited or no resources. An HIV case manager/social worker can help link the patient to an individual counselor or a support group (online or in person). There are trained professionals that can help patients talk about their feelings, talk to partners about the diagnosis, safe sex and dealing with learning about the diagnosis during pregnancy.
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