If the patient is not in labor, and delivery is not imminent, confirmatory testing should be conducted and the patient managed accordingly.
FAQs
Although HIV status is known in the majority of pregnant people or a rapid HIV test is done during delivery, in a small number of newborns the birthing parent’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 with HIV exposure can still prevent infection in almost half of infants.
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 zidovudine (AZT) as soon as possible and likely additional antiretroviral medications. Treatment of newborns exposed to HIV should continue until the birth parent's confirmatory HIV test result is available. See 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 for more detailed information.
An early infant bath should be completed in the delivery room prior to the administration of intramuscular injections or any invasive intervention. An appropriate protocol should include cleansing with chlorhexidine antiseptic solution, which is readily available in most labor and delivery units.
Formula feeding is the only way to eliminate the risk of breastmilk transmission of HIV. However, if a person with HIV expresses interest in breast/chestfeeding, shared decision making and non-judgmental counseling should be provided as outlined in the DHHS Perinatal HIV Guidelines Infant Feeding for Individuals with HIV in the United States. Clinicians should consult experts in pediatric HIV if a person with HIV chooses to breast/chestfeed.
Yes, antiretroviral therapy is currently recommended for all individuals living with HIV to reduce the risk of disease progression and to prevent HIV sexual transmission. Additionally, antiretroviral therapy postpartum is also important to help the patient maintain viral suppression prior to subsequent pregnancies.
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.
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.
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.
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.
