HIV in pregnancy

Question 1

Transmission and how to reduce it

Answer 1

Highest risk during birth (perinatal vertical transmission)
Risk depends on maternal viral load

Reducing risk of transmission
Combined antiretroviral therapy (cART) is recommended throughout pregnancy

Delivery method
Viral load > 1,000 copies/mL (or unknown) near time of delivery: increased risk of HIV transmission
Cesarean delivery should be scheduled at 38 weeks
HIV post-exposure prophylaxis with zidovudine, lamivudine and nevirapine OR zidovudine and nevirapine
Viral load ≤ 1,000 copies/mL and mother has received cART during pregnancy: low risk of HIV transmission
Vaginal delivery may be considered
HIV post-exposure prophylaxis with zidovudine for the newborn

Question 2

Diagnosis in infants and CF

Answer 2

Diagnosis in infants: if < 18 months, diagnosis is confirmed via PCR, not ELISA
Suspect HIV in infants with failure to thrive, diffuse lymphadenopathy, diarrhea, and thrush, especially if the mother is a high-risk parent!