Perinatal transmission of bloodborne infections
From IDWiki
Investigations
Unknown maternal serostatus
- 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
HIV
- Risk of transmission from an untreated HIV-positive mother is approximately 25%, but less than 1% if treated
| Viral Load | Management of Mother | Management of Infant | ||
|---|---|---|---|---|
| ART | Zidovudine | C-section | ||
| <40 | yes | yes | no | zidovudine for 4 to 6 weeks |
| 40-999 | yes | yes | consider | combination ART, or zidovudine monotherapy for 4-6 weeks |
| ≥1000 | yes | yes | yes | combination ART |
| unknown | yes | yes | yes | combination ART, adjusted based on results of maternal viral load |
Management of Mother
- See HIV in pregnancy for information about managing the mother ante-, intra-, and postpartum
- Mothers should be treated with antiretroviral therapy and monitored during pregnancy
- Intrapartum management is based on viral load, and includes continuing antiretrovirals, giving intravenous zidovudine during labour, and consideration of Cesarean section
- Following delivery, mothers should be counselled about the risks of breastfeeding
Management of Neonate
- See prevention of neonatal HIV for information about preventing disease in the newborn
- An HIV PCR should be obtained within 48 hours of delivery, then regularly following delivery
- If any single HIV PCR test is positive, then they are diagnosed with HIV and need ongoing treatment
- A decision to treat the infant with either zidovudine monotherapy for 4 to 6 weeks, or presumptive antiretroviral therapy for at least 6 weeks, depends on the risk of infection
