Perinatal transmission of bloodborne infections

Diagnosis

Up to 18 months of age, only use HIV PCR
- In general, all infants with perinatal exposure should be checked at 14 to 21 days, 1 to 2 months, and 4 to 6 months
- If high risk, can also check at birth and 2 to 4 weeks after stopping antiretrovirals
- Confirm a positive result with repeat testing
Serology can be tested starting at 18 to 24 months

VL	Antenatal Rx	C-section	Neonatal Rx
>1000	Any	Yes	ART
40-999	None	Yes	ART
40-999	ART	Maybe	ART
<40	None	Maybe	ART
<40	ART	No	Zidovudine x4 weeks
Unknown	None	Maybe	ART
Unknown	ART	Maybe	Unclear

If possible, send STAT maternal HIV serology, HBV, HCV, and syphilis; can consider viral load
For infant:
- At birth send HIV, HBV (sAg, sAb, cAb), HCV-Ab, and syphilis serologies, as well as an HIV PCR (not viral load)
- Repeat HIV PCR at 1, 2, and 4-6 months

Age	Investigations	Management
Birth	CBC/diff, ALT, lactate, and HIV PCR	Start ART as described below
7 days	CBC/diff, nevirapine level	Dose-adjust nevirapine if needed
14 days	CBC/diff, nevirapine level, and HIV PCR	Dose-adjust nevirapine if needed
4 weeks	CBC/diff and ALT; ?HIV PCR?	Stop nevirapine if prior HIV PCR is negative, and continue other ART
6 weeks	?HIV PCR?	Stop zidovudine and lamivudine if HIV PCR has been negative
2 months		Review as needed
6 months	CBC/diff and ALT
18 months	HIV serology	Developmental assessment
3.5 years		Developmental assessment
5.5 years		Developmental assessment

Can either do a prophylactic regimen, or treat empirically
Prophylaxis:
- ZDV/NVP: zidovudine x6 weeks, plus nevirapine x3 in the first week of life
Empiric treatment:
- ZDV/3TC/NVP: zidovudine fir 6 weeks, plus lamivudine and nevirapine for 2 to 6 weeks
- ZDV/3TC/RAL: zidovudine for 6 weeks, plus lamivudine and raltegravir for 2 to 6 weeks