Management of Infants Born to Women with HIV Infection
Initial Postnatal Management of the Neonate Exposed to HIV
Last Updated: December 24, 2019; Last Reviewed: December 24, 2019
Panel's Recommendations for Initial Postnatal Management of the Neonate Exposed to HIV
- All newborns who were perinatally exposed to HIV should receive appropriate antiretroviral (ARV) drugs as soon as possible after delivery (see Antiretroviral Management of Newborns with Perinatal HIV Exposure or HIV Infection) (AI).
- A complete blood count and differential should be performed on newborns as a baseline evaluation (BIII).
- Infants who are found to have hematologic abnormalities may need to discontinue ARV drugs. Clinicians should base the decision to discontinue ARV drugs on the individual needs of the patient. Consultation with an expert in pediatric HIV infection is advised if early discontinuation of ARV drugs is considered (CIII).
- When determining the timing for subsequent monitoring of hematologic parameters in infants, clinicians need to consider the infant’s baseline hematologic values, gestational age at birth, and clinical condition; whether the infant is receiving zidovudine (ZDV), other ARV drugs, or certain concomitant medications; and the specific ARV drugs used in the mother’s antepartum drug regimen (CIII).
- Hemoglobin and neutrophil counts should be remeasured 4 weeks after initiating an ARV regimen that contains ZDV and lamivudine (AI).
- Virologic tests are required to diagnose HIV infection in infants aged <18 months (see Diagnosis of HIV Infection in Infants and Children) (AII).
- To prevent Pneumocystis jirovecii pneumonia (PCP), all infants born to women with HIV should begin PCP prophylaxis at ages 4 to 6 weeks, after completing their ARV prophylaxis or an empiric HIV therapy regimen, unless there is adequate test information to presumptively exclude HIV infection (see the Pediatric Opportunistic Infection Guidelines) (AII).
- Health care providers should routinely inquire about infant feeding plans and/or breastfeeding desires, as well as the use of premasticated (prechewed or prewarmed) food. Counseling against premastication and discussion of safe infant feeding options should be provided (see Counseling and Managing Women Living with HIV in the United States Who Desire to Breastfeed) (AIII).
|Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials with clinical outcomes and/or validated laboratory endpoints; II = One or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = Expert opinion