Case (29)

[Doctoor]

Ahealthy 24 year-old woman was tested during her first pregnancy and found to be HIV positive. A second, confirmatory test also was
positive. She did not take nevirapine at the onset of labour and her newborn baby was not given nevirapine within three days after birth.
Today the woman brings her two-month-old baby to clinic to learn if he too is infected with HIV. The baby appears healthy and weighs
3.5 kilograms.

Questions:
1- Is this baby infected with HIV?
2- How do you know?
3- How can one prevent infection of HIV from mother to baby?

[Yaxya]

If the mother is infected with HIV she will transmit her HIV antibodies to her child so if we test HIV antibodies it will be positive although the child may not necessarily infected so the best way is to make sure that her baby infected is by testing DNA or RNA PCR ..
So if the baby is more than 1 month and one of these tests or both of them are negative then we are sure that child is not infected.
We can prevent vertical transmission by the following methods:
-Treating the HIV+ mother with a Retrovir (AZT, zidovudine) containing regimen during pregnancy.
-Giving the mother a dose of intravenous (IV) Retrovir during delivery.
-Treating the newborn with oral Retrovir for six weeks after birth.

[Doctoor]

It's not correct, try again....

[Kassim]

1-Is this baby infected with HIV?
Mother-to-child transmission (MTCT) is when an HIV positive woman passes the virus to her baby. This can occur during pregnancy, labour and delivery, or breastfeeding. Without treatment, around 15-30% of babies born to HIV positive women will become infected with
HIV during pregnancy and delivery. A further 5-20% will become infected through breastfeeding.
This means this baby has 20-50% to be HIV infected.  Therefore we can predict it what are his chances of being infected, but can only be confirmed by HIV test.

2- How do you know?
Because positive antibody results alone do not establish infection in children younger than 18 months of age, therefore Children who are younger than 18 months of age and are born to an HIV-infected mother is best to use one of the following methods:
•   HIV DNA PCR (preferred method)
•   HIV culture (acceptable method)
Because infection can only be confirmed with two positive test results performed on samples collected at different times, a repeat sample should be obtained promptly for any child with a single positive test result.
In an infant younger than 18 months of age, HIV can be reasonably excluded with two negative HIV viral tests, one at 1 month of age or older, and the other at age 4 months or older.
Ideally, a DNA PCR should be obtained for HIV-exposed infants at each of the following time points:
•   at birth
•   at 2 weeks of age
•   at 4 to 6 weeks of age
•   at 6 to 12 weeks of age
•   at 4 to 6 months of age
3-   How can one prevent infection of HIV from mother to baby?

Effective prevention of mother-to-child transmission (PMTCT) requires a three-fold strategy.
•   Preventing HIV infection among prospective parents
•   Avoiding unwanted pregnancies among HIV positive women
•   Preventing the transmission of HIV from HIV positive mothers to their infants during pregnancy, labour, delivery and breastfeeding.
WHO guidelines for PMTCT drug regimens   

                       Pregnancy                                        Labour                        After birth: mother             After birth: infant
         
Recommended         AZT after 28 weeks             single dose nevirapine;     AZT+3TC for 7 days        single dose nevirapine; AZT 7 days
                                                                    AZT+3TC               

Alternative higher
risk of drug resistance)   AZT after 28 weeks         single dose nevirapine                                        single dose nevirapine; AZT 7 days                           

Minimum (less effective)                                    single dose nevirapine;      AZT+3TC for 7 days      single dose nevirapine
                                                                              AZT+3TC                     

Minimum
(less effective;                                               single dose nevirapine                                          single dose nevirapine
higher risk of drug resistance)


   

Caesarean sections
When a mother is HIV positive a caesarean section may be done to protect the baby from direct contact with her blood and other bodily fluids and is recommended if the mother has a high level of HIV in her blood.  If the mother is taking combination antiretroviral therapy then a caesarean section will often not be recommended because the risk of HIV transmission will already be very low.
Breastfeeding
Mothers with HIV are advised not to breastfeed, other alternative should be used.

hope this is right answer
kassim

[Doctoor]

Any baby born to a sero-positive mother also will be sero-positive for the first 12 months of life. Some babies still are seropositive for as long as 18 months after birth. For this reason, it is useless to test this baby at two months because he will always be seropositive.

HIV rapid tests detect only HIV anti-body.

The anti-bodies from the mother pass the placenta to the baby and thus the baby will test sero-positive until the mother's anti-bodies fade away sometime in the first 18 months of life.

For this reason, do not test the baby with an HIV rapid test until the baby is 18 months of age. By that time, if the baby truly is infected with HIV, it will be his own anti-bodies giving a positive test result.

If it is important to know soon if the baby truly is infected with HIV, then a PCR test can be requested within the first week of the baby's life.

This test is expensive and usually is not done in resourcepoor settings if the baby appears healthy.

Remember, only about 30 % of babies of HIV-infected mothers are infected with the mother's HIV. Most (70%) babies are not infected.
This 30% figure is reduced to 12-15% by giving Nevirapine to both the mother during labor and within 48 hours of birth to the baby.

If AZT is used from week 28 of pregnancy, transmission to the baby can be reduced to below 10%. If full dose HAART is used from week 24 until the end of breast feeding (or 6 months), transmission rates can be reduced to as low to as low as 1%.

Cesarean section is advised in such case.

There is now good evidence that supports giving all newborns of HIV + mothers prophylactic cotrimoxazole, beginning at six weeks of
life and continuing for eighteen months. Prophylactic cotrimoxazole is protective of the pneumonias common to HIV-infected babies. If
the baby is not HIV-infected, then cotrimoxazole usually does no harm.
Thanks Kassim & Yaxya for your participation, therefore I request from the Admins to split points between them.
Doctoor