Evaluation and Treatment of the Human Immunodeficiency Virus-1—Exposed Infant

Abstract

ABSTRACT. In developed countries, care and treatment are available for pregnant women and infants that can decrease the rate of perinatal human immunodeficiency virus type 1 (HIV-1) infection to 2% or less. The pediatrician has a key role in prevention of mother-tochild transmission of HIV-1 by identifying HIV-exposed infants whose mothers' HIV infection was not diagnosed before delivery, prescribing antiretroviral prophylaxis for these infants to decrease the risk of acquiring HIV-1 infection, and promoting avoidance of HIV-1 transmission through human milk. In addition, the pediatrician can provide care for HIV-exposed infants by monitoring them for early determination of HIV-1 infection status and for possible short-and long-term toxicities of antiretroviral exposure, providing chemoprophylaxis for Pneumocystis pneumonia, and supporting families living with HIV-1 infection by providing counseling to parents or caregivers. Pediatrics 2004;114:497-505; HIV-1, mother-to-child transmission, HIV-exposed infants, antiretroviral, diagnosis.

Audiologic and vestibular findings in a sample of Human Immunodeficiency Virus type-1-infected Mexican children under Highly Active Antiretroviral Therapy

“…Therefore, this sample seems to be representative of the wide variety of HIV disease in pediatrics [15,16,18]. Even though standard therapy for pediatric patients is based on the combination of one protease inhibitor or one non-nucleoside reverse transcriptase inhibitor plus two nucleoside analog reverse transcriptase inhibitors (NRTI) [16,20], most of our patients were receiving a regimen based on the combination of two PIs plus two NRTIs, because most of them came from a cohort being evaluated for comparison of two different antiretroviral regimens [21].…”

“…A number of studies have demonstrated that children with perinatally acquired HIV-1 infections start to have symptoms earlier than adult patients [18,43,44], and usually have higher VLs [15,18,20,43]. The VL at the initiation of HAART and at the time of audiologic evaluation was higher in patients with HL.…”

“…A diagnosis of HIV-1 infection for infants less than 18 months of age was established with at least two positive HIV-1 RNA PCR assays [15,16], and for older children by detection of anti-HIV-1 antibodies by ELISA and Western blot tests [17,18]. Patients with a history of ear surgery or trauma, congenital hearing loss, or any central nervous system disease not related to HIV-1 infection were not eligible.…”

Evaluation of 4 Weeks' Neonatal Antiretroviral Prophylaxis as a Component of a Prevention of Mother-to-child Transmission Program in a Resource-rich Setting

“…28 -30 In many resource-rich countries, programs for PMTCT incorporate 6 weeks' neonatal ARV prophylaxis as standard practice. 4,5,8 Discussion continues as to whether in non-breastfeeding populations abbreviated-neonatal ARV regimens can yield optimal results. As yet the long-term outcome of in utero and neonatal ARV exposure remains to be fully defined, however, given the known potential for adverse events, 9,12,[31][32][33] it is reasonable to limit exposure where possible, provided the very real benefit of preventing HIV transmission is not compromised.…”

“…3 US guidelines recommend 6-week neonatal ARV prophylaxis for exposed infants. 4,5 This derives from the pivotal ACTG 076 study, 6 but the absolute need for a 6-week treatment duration is not evidencebased. Animal model data support 4 weeks duration for prophylaxis after a definite inoculation.…”