HIV (3)

Question 1

How can it be transmitted to children?

Answer 1

Vertically during pregnancy, birth or breastfeeding

Question 2

Prevention of Transmission During Birth:
How is the mode of delivery determined by the mother’s viral load?

How is prophylaxis given to babies at risk?

Answer 2

➊ • Normal vaginal – < 50 copies/ml
• C-section – > 50 copies/ml

➋ • Low risk babies where mother < 50 copies/ml – Zidovudine for 4 wks
• High risk babies where mother > 50 copies/ml – Zidovudine, Lamivudine and Nevirapine for 4 wks

Question 3

Testing:
When should babies to a HIV +Ve mother be tested?
→ Why may the Ab test be falsely +ve during the first yr or so?

When else should testing be done?

Answer 3

➊ * HIV Viral load at 3 months – If -ve, baby hasn’t contracted HIV during birth
* HIV Ab test at 24 months – Check to see if they’ve contracted HIV since their 3 month viral load test e.g. through breastfeeding
→ Due to maternal Ab’s that crossed the placenta

➋ * When immunodeficiency suspected e.g. unusual/severe/frequent infections
* Young and sexually active
* Risk factors present – Sexual abuse is a major one to consider if suspected

Question 4

How is it managed?

Answer 4

• ART – Aim for normal CD4 and undetectable viral load
• Vaccinations – Avoid live vaccines if severely immunocompromised
• Prophylactic Co-trimoxazole in children with low CD4 to protect against PCP