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Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States

Postpartum Management

Infants Born To Mothers with Unknown HIV Infection Status

(Last updated:9/14/2011)

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Panel’s Recommendations:
  • For infants born to mothers with unknown HIV status, rapid HIV antibody testing of the mother and/or infant is recommended as soon as possible after birth, with immediate initiation of infant antiretroviral (ARV) prophylaxis (see Infant Antiretroviral Prophylaxis) if the rapid test is positive (AII). In the setting of a positive test, standard antibody confirmatory testing such as a Western blot also should be performed on mothers (or their infants) as soon as possible. If the confirmatory test is negative, ARV prophylaxis can be discontinued (AIII).
  • If the HIV antibody confirmatory test is positive, a newborn HIV DNA polymerase chain reaction (PCR) should be obtained (AIII).
  • If the newborn HIV DNA PCR is positive, ARV prophylaxis should be discontinued and the infant promptly referred to a pediatric HIV specialist for confirmation of the diagnosis and treatment of HIV infection with standard combination antiretroviral therapy (ART) (AI).

Rapid HIV antibody testing of mothers and/or infants is recommended as soon as possible after birth when maternal HIV status is unknown and rapid HIV antibody testing was not performed during labor. If rapid testing is positive, infant ARV prophylaxis should be initiated immediately. Rapid HIV antibody testing should be available on a 24-hour basis at all facilities with a maternity service and/or neonatal intensive care or newborn nursery. A positive test result in mothers or infants should be presumed to indicate maternal HIV infection until standard antibody confirmatory testing clarifies maternal status. A standard confirmatory test (e.g., Western blot) should be performed on mothers (or their infants) as soon as possible after the initial positive rapid test [1]. A positive HIV antibody test in an infant indicates maternal but not necessarily infant HIV infection; diagnosis of HIV infection in infants younger than age 18 months requires virologic testing. If the confirmatory test on a mother (or infant) is negative, ARV prophylaxis can be discontinued. If the confirmatory test is positive, an HIV DNA PCR should be obtained urgently from the newborn. If the HIV DNA PCR is positive, ARV prophylaxis should be promptly discontinued and the infant should receive treatment for HIV infection with standard combination ART according to established Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection developed by The Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children.

Reference

1. Centers for Disease Control and Prevention (CDC). Rapid HIV-1 antibody testing during labor and delivery for women of unknown HIV status: a practical guide and model protocol. 2004; www.cdc.gov/hiv/topics/testing/resources/guidelines/pdf/Labor&DeliveryRapidTesting.pdf.