Thread: Ahealthy 24 year-old woman was tested during her first pregnancy

Case Report:

A healthy 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.

***

• Is this baby infected with HIV?

• How do you know?

• How can one prevent infection of HIV from mother to baby?

COMMENT/ Explanation:

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COMMENT: 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%.

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.
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