Perinatal transmission of bloodborne infections: Difference between revisions
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− | * |
+ | *Main risk is for [[HIV]] and [[HBV]] |
− | == |
+ | ==Investigations== |
+ | =====Unknown maternal serostatus===== |
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− | * Up to 18 months of age, only use '''HIV PCR''' |
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− | ** In general, all infants with perinatal exposure should be checked at 14 to 21 days, 1 to 2 months, and 4 to 6 months |
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− | ** If high risk, can also check at birth and 2 to 4 weeks after stopping antiretrovirals |
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− | ** Confirm a positive result with repeat testing |
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− | * '''Serology''' can be tested starting at 18 to 24 months |
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+ | *If possible, send STAT maternal HIV serology, HBV, HCV, and syphilis; can consider viral load |
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− | == Management == |
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+ | *For infant: |
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− | === Preventative management === |
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+ | **At birth send HIV, HBV (sAg, sAb, cAb), HCV-Ab, and syphilis serologies, as well as an HIV PCR (''not'' viral load) |
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− | * Immediate management depends on maternal viral load and treatment status |
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+ | **Repeat HIV PCR at 1, 2, and 4-6 months |
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− | * In general, a mom with HIV should get IV zidovudine during labour |
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+ | |||
+ | ==HIV== |
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+ | |||
+ | *Risk of transmission from an untreated HIV-positive mother is approximately 25%, but less than 1% if treated |
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{| class="wikitable" |
{| class="wikitable" |
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+ | ! rowspan="2" |Viral Load |
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− | ! VL !! Antenatal Rx !! C-section !! Neonatal Rx |
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+ | ! colspan="3" |Management of Mother |
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+ | ! rowspan="2" |Management of Infant |
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|- |
|- |
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+ | ![[HIV treatment|ART]] |
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− | | >1000 || Any || Yes || ART |
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+ | ![[Zidovudine]] |
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+ | ![[Cesarean section|C-section]] |
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|- |
|- |
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+ | |<40 |
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− | | 40-999 || None || Yes || ART |
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+ | |yes |
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+ | |yes |
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+ | |no |
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+ | |[[zidovudine]] for 4 to 6 weeks |
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|- |
|- |
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+ | |40-999 |
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− | | 40-999 || ART || Maybe || ART |
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+ | |yes |
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+ | |yes |
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+ | |consider |
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+ | |combination ART, or [[zidovudine]] monotherapy for 4-6 weeks |
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|- |
|- |
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+ | |≥1000 |
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− | | <40 || None || Maybe || ART |
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+ | |yes |
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+ | |yes |
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+ | |yes |
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+ | |combination ART |
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|- |
|- |
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+ | |unknown |
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− | | <40 || ART || No || [[Zidovudine]] x4 weeks |
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− | | |
+ | |yes |
+ | |yes |
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− | | Unknown || None || Maybe || ART |
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− | | |
+ | |yes |
+ | |combination ART, adjusted based on results of maternal viral load |
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− | | Unknown || ART || Maybe || Unclear |
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|} |
|} |
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− | + | === Management of Mother === |
|
− | * 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) |
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− | ** Repeat HIV PCR at 1, 2, and 4-6 months |
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+ | * See [[HIV in pregnancy]] for information about managing the mother ante-, intra-, and postpartum |
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− | ==== Post-exposure follow-up ==== |
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+ | * Mothers should be treated with antiretroviral therapy and monitored during pregnancy |
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− | {| class="wikitable" |
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+ | * Intrapartum management is based on viral load, and includes continuing antiretrovirals, giving intravenous [[zidovudine]] during labour, and consideration of [[Cesarean section]] |
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− | ! Age !! Investigations !! Management |
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+ | * Following delivery, mothers should be counselled about the risks of breastfeeding |
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− | |- |
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+ | |||
− | | Birth || CBC/diff, ALT, lactate, and HIV PCR || Start ART as described below |
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+ | === Management of Neonate === |
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− | |- |
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+ | |||
− | | 7 days || CBC/diff, nevirapine level || Dose-adjust nevirapine if needed |
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+ | * See [[Neonatal HIV#Prevention|prevention of neonatal HIV]] for information about preventing disease in the newborn |
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− | |- |
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+ | * An HIV PCR should be obtained within 48 hours of delivery, then regularly following delivery |
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− | | 14 days || CBC/diff, nevirapine level, and HIV PCR || Dose-adjust nevirapine if needed |
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+ | ** If any single HIV PCR test is positive, then they are diagnosed with HIV and need ongoing treatment |
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− | |- |
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+ | * 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 |
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− | | 4 weeks || CBC/diff and ALT; ?HIV PCR? || Stop nevirapine if prior HIV PCR is negative, and continue other ART |
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+ | |||
− | |- |
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+ | ==Hepatitis B virus== |
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− | | 6 weeks || ?HIV PCR? || Stop zidovudine and lamivudine if HIV PCR has been negative |
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+ | |||
− | |- |
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+ | *[[Hepatitis B in pregnancy#Management|Management of the mother]] |
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− | | 2 months || || Review as needed |
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+ | *[[Neonatal HBV#Prevention|Management of the neonate]] |
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− | |- |
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+ | |||
− | | 6 months || CBC/diff and ALT || |
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+ | ==Hepatitis C virus== |
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− | |- |
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+ | |||
− | | 18 months || HIV serology || Developmental assessment |
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+ | *[[Hepatitis C virus#Management|Management of the mother]] |
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− | |- |
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+ | *[[Neonatal HCV|Management of the neonate]] |
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− | | 3.5 years || || Developmental assessment |
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− | |- |
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− | | 5.5 years || || Developmental assessment |
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− | |} |
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+ | ==Further Reading== |
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− | === Selection of antiretrovirals === |
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− | * Can either do a prophylactic regimen, or treat empirically |
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− | * Prophylaxis: |
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− | ** ZDV/NVP: [[Zidovudine#Neonatal HIV prophylaxis|zidovudine]] x6 weeks, plus [[nevirapine#Neonatal HIV prophylaxis|nevirapine]] x3 in the first week of life |
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− | * Empiric treatment: |
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− | ** ZDV/3TC/NVP: [[Zidovudine#Neonatal HIV prophylaxis|zidovudine]] fir 6 weeks, plus [[lamivudine#Neonatal HIV prophylaxis|lamivudine]] and [[nevirapine#Neonatal HIV prophylaxis|nevirapine]] for 2 to 6 weeks |
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− | ** ZDV/3TC/RAL: [[Zidovudine#Neonatal HIV prophylaxis|zidovudine]] for 6 weeks, plus [[lamivudine#Neonatal HIV prophylaxis|lamivudine]] and [[raltegravir#Neonatal HIV prophylaxis|raltegravir]] for 2 to 6 weeks |
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+ | *AIDSinfo. [https://aidsinfo.nih.gov/guidelines/html/3/perinatal/187/antiretroviral-management-of-newborns-with-perinatal-hiv-exposure-or-perinatal-hiv Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States]. |
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− | == Further Reading == |
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+ | *Ontario HIV Treatment Network. [http://www.ohtn.on.ca/mother-to-child/ Guidelines for the Prevention of Mother-to-Child HIV Transmission]. 2017. |
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− | * AIDSinfo. [https://aidsinfo.nih.gov/guidelines/html/3/perinatal/187/antiretroviral-management-of-newborns-with-perinatal-hiv-exposure-or-perinatal-hiv Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States]. |
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[[Category:HIV]] |
[[Category:HIV]] |
Latest revision as of 11:28, 18 September 2020
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