perinatal AIDS


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perinatal AIDS

acquired immunodeficiency syndrome acquired by infants and children from their mothers during pregnancy, during delivery, or from ingesting infected breast milk. See acquired immunodeficiency syndrome.

perinatal AIDS

Infection with HIV as a result of vertical transmission of the virus from an infected mother. Worldwide, in 2002, 1500 children were infected every day by maternal to child transmission of the disease; the overwhelming majority of these children live in developing nations. In the U.S. between 1992 and 1997, testing pregnant women to identify HIV infection and treating affected people with zidovudine decreased the risk of perinatal AIDS by about 70%.

Transmission

Transmission of HIV to infants occurs in utero, during labor and delivery, and through breastfeeding. Approx. 50% to 70% of infants are infected during childbirth, esp. during preterm birth with prolonged rupture of membranes; 30% to 50% are infected in utero; 20% of HIV-positive mothers can transmit the infection through breastfeeding.

Diagnosis

The diagnosis is made through two positive blood test results for the presence of HIV or the growth of HIV in culture. Transmission is unlikely to occur in women whose viral load of HIV RNA has been reduced by effective antiretroviral therapy. The Centers for Disease Control and Prevention (CDC) recommends that all adults, ages 13-64 years, should be offered routine HIV testing (with the choice to opt out), rather than testing only those patients with known risk factors for the disease.

Symptoms

Infants may be asymptomatic even when infected with HIV. Infection is monitored by measuring the absolute CD4+ T-cell count, measuring the amount of virus in the blood (viral load), and assessing for the presence of opportunistic infections in infancy or early childhood. Over time, the infected infant may present with Pneumocystis carinii (P. jiroveci) pneumonia, chronic diarrhea, recurrent bacterial infections, failure to thrive, developmental delays, and recurrent Candida and herpes simplex infections. The majority of perinatally infected children develop an AIDS-defining illness by the age of 4. Anemia and neutropenia may occur as side effects of drug therapy.

Treatment

Zidovudine (AZT) is given for 6 weeks to all infants born of HIV-positive mothers. Prophylaxis for P. carinii (P. jiroveci) pneumonia with trimethoprim-sulfamethoxazole begins at 6 weeks and continues for 6 months in children whose HIV test results are negative and for 1 year in infected infants. The use of highly active highly active antiretroviral therapy (HAART) is being studied. Breastfeeding is contraindicated for all HIV-infected mothers to minimize the risk of transmission of the virus.

Patient care

Women in their childbearing years who engage in high-risk behavior and women whose husbands or primary sexual partner may engage in high risk behavior should be counseled to be tested for HIV before becoming pregnant or as soon as they know they are pregnant in order to reduce the risk of infection the baby. Women who are HIV-positive should begin antiretroviral therapy immediately. Standard precautions are used with babies born of HIV-positive mothers until diagnostic tests indicate that they are not infected. Mothers and other care providers must be instructed in the use of these precautions and to watch for and quickly report respiratory infections.

Adapted from CDC:MMWR 41 (RR-17):2-3, 15, 1992.
AIDS wasting syndromeKaposi sarcoma
Candida infections (candidiasis) of the trachea, bronchi, lungs, or esophagusLeukoencephalopathy, progressive multifocal
Cervical cancer, invasiveLymphoma: Burkitt; immunoblastic; non-Hodgkin; primary brain
Cryptococcus neoformans: Extrapulmonary infectionsMycobacterium avium complex or M. kansasii: Extrapulmonary or disseminated infections
Cryptosporidium: Chronic (lasting more than a month) infections of the gastrointestinal tract*Mycobacterium tuberculosis: Pulmonary or extrapulmonary infections
Cytomegalovirus: Infections other than those in liver, spleen, or lymph nodes; cytomegalovirus retinitis with loss of visionMycobacterium, other species: Extrapulmonary infections or disseminated
Encephalopathy, HIV-relatedPneumonia, Pneumocystis carinii
Herpes simplex: Chronic (lasting more than a month) oral ulcers, bronchitis, pneumonitis, or esophagitisPneumonia, recurrent
Histoplasma capsulatum: Extrapulmonary or disseminated histoplasmosis infectionsToxoplasma gondii: Infections (toxoplasmosis) of the brain, heart, or lung
Isosporiasis, chronic (lasting more than a month) intestinal
See also: AIDS