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Case History:

This 29-year-old mother came to clinic six weeks after delivering her fourth child. She did not accept PMTC counseling and testing in the ante-natal clinic. In the six-week post-natal clinic, because of her sickly appearance, the nurse referred her for VCT counseling and testing, which she accepted. The result was sero-positive.

This mother had not returned to full activity after delivery. She only stayed at home and nursed her new baby. She lost some weight and felt swellings in her neck. Two weeks ago, she began to feel some burning pain over her right eye and forehead. Because this mother feared that she might transmit some sickness to her healthy baby, she took the baby to a nearby clinic. The baby was tested by HIV rapid test and found to be sero-positive. The mother comes with her baby to you for help.
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• How can this mother's baby be HIV positive and still appear healthy?
• What medicines should both the mother and the baby take?
• How could this baby's risk of HIV infection have been reduced?





COMMENT:

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Since the mother is HIV positive, it is normal that the baby also is HIV positive up until he is 18 months of age. The HIV rapid test measures only mother's antibody which is transmitted through the placenta to the baby, and this mother's antibody lasts as long as 18 months in the baby's blood. A PCR or viral load test may give a definitive diagnosis earlier than 18 months, but is expensive. The baby should be given cotrimoxazole prophylaxis from 6 weeks until the 18 month HIV test is done. Cotrimoxazole saves lives,prevents infections and prevents immune decline.

The mother already is showing symptoms and signs of AIDS. Burning pain over her left eye could be the early manifestation of shingles. Swellings in her neck could be early signs of tuberculosis lymphadenitis or from HIV disease itself. Single enlarged nodes in patients with AIDS also can be caused by lymphoma; she would benefit from a biopsy of the nodes. A full blood count and/or a CD4 count should be done to know what stage of HIV infection she now has. She and her baby both should receive cotrimoxazole and ARVs
if appropriate.
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