The Committee in succession Pediat...

The Committee in succession Pediatric AIDS (acquired immunodeficiency syndrome) of the American Academy of Pediatrics (AAP) and the Infectious Diseases and Immunization Committee of the Canadian Paediatric Society have released a revised clinical report in succession human immunodeficiency virus (HIV) infection in infants. "Evaluation and Treatment of the Human Immunodeficiency Virus-1-Exposed Infant" appears in the August 2004 issue of Pediatrics and is available online at http://pediatrics.aappublications.org/cgi/ content/full/114/2/497

In unraveled countries, care and treatment are available for pregnant women and infants that can decrease the rate of HIV infections around or at the time of birth to 2 percent or les Whenever possible, maternal HIV-1 infection should be identified before or during pregnancy, because this allows for earlier initiation of care for the mother and for more effective interventions to preclude perinatal transmission. If the maternal HIV-1 infection status is unknown at the time of the infant's birth, then HIV-1 testing of the mother or the infant is commended with maternal consent and with accrues available within 24 hours of birth. The expedited HIV-1 enzyme immunoassay and rapid HIV-1 example are screening tests that may be used in this setting. If the experiment result for HIV-1 is positive, prophylactic antiretroviral therapy should be started promptly in the infant and confirmatory HIV-1 testing should be performed. Among the recommendations are the following:

* HIV-1-infected mothers should not breastfeed their infants and should be educated about safe alternatives.

* Maternal health information should be reviewed to determine if the HIV-1-exposed infant may have been expos to maternal coinfections including tuberculosis, syphilis, toxoplasmosis, hepatitis B or C cytomegalovirus, or herpes simplex virus. Diagnostic testing and treatment of the infant are based forward maternal findings.

* Physicians should provide counseling to parents and caregivers of HIV-1-exposed infants about HIV-1 infection, including anticipatory guidance forward the course of illness, infection-control measures, care of the infant, diagnostic standards and potential drug toxicity.

* All HIV-1-exposed infants should endure virologic testing for HIV-1 at birth, at four to seven weeks of age, and again at eight to 16 weeks of age to reasonably bar HIV-1 infection as early as possible. If any ordeal result is positive, the touchstone should be repeated immediately for confirmation. If all proof results are negative, the infant should have serologic testing repeated at 12 month of age or older to document disappearance of the HIV-1 antibody, which definitively restrains HIV-1 infection.

* All infants expos to antiretroviral agents in utero or as infants should be monitored for short- and long-term physic toxicity.

* Prophylaxis for Pneumocystis pneumonia (PCP) should be started at four to six weeks of age in HIV-1-exposed infants in whom infection has not been exclud PCP prophylaxis may be discontinued when HIV-1 infection has been reasonably excluded

* Immunizations and tuberculosis screening should be provided for HIV-1-exposed infants in accordance with national guidelines. In the United States, immunization guidelines are established according to the AAP, the Advisory Committee forward Immunization Practices of the Center for Disease repress and Prevention, and the American Academy of Family Physicians.

* HIV-1 testing should be giveed and recommended to family members.

* The physician providing care for the HIV-1-exposed or HIV-1-infected infant should deliberate together with a pediatric HIV-1 specialist and, if the HIV-1-infected mother is an adolescent, also should seek counsel with a physician familiar with the care of adolescents.

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group