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PED: ZIDOVUDINE (PO-7233)
2013 Evaluation and Treatment of Infants Exposed to HIV-1
Evaluation for HIV infection in the infant should begin at birth. A confident diagnosis can usually be made by 4 months of age. Please inform the Pediatric Infectious Diseaseservice when you become aware of an HIV exposed newborn; if the mother had an undetectable viral load and was taking antiretrovirals during pregnancy, a stat consult isnot required. Please page the attending on call (all hours) for a stat consult in the following high transmission risk situations: (1) most recent maternal HIV viral load is
>1,000 copies/mL (2) mother who did not receive antiretrovirals (ARV) during pregnancy nor labor (3) Mother who received only intrapartum ARV (no prenatal ARV)(4) mother with known high-level antiretroviral resistance.
-Bathe newborn prior to vitamin K or hepatitis B vaccine injections
-Formula feed only (breastfeeding is contraindicated, even if mother’s HIV viral load is undetectable)
-Begin zidovudine (Retrovir) ASAP, by 12 hours of life; see dosing below
-For high risk cases, ID may recommend adding nevirapine ASAP (see above for definition of “high risk”)
-Can give first dose prior to collecting HIV DNA PCR
-Order labs (see table below): HIV Qualitative DNA PCR and CBC with differential
-Blood draw can be done by routine phlebotomy (“stat” not required)
**DO NOT SEND HIV ANTIBODY; IT IS ALWAYS POSITIVE! (maternal antibody)**
-Consult Pediatric Infectious Disease service (page ID team on call, does not require stat consult)
-Review maternal prenatal records for other significant infections (RPR, Hep B, Hep C)
-All infant vaccines can be given on routine schedule; determine if HBIG is indicated
Hospital Discharge and Follow Up Plan
-Send home with a 6 week supply of Retrovir. Encourage parents to fill Rx at OHSU prior to discharge.
-Be certain parents know how to draw up the correct volume into medicine syringe.
-Pediatric ID team on call will assist with scheduling the baby’s 2-week ID clinic appointment.
-The 2-week ID clinic appointment date and time should be included on baby’s discharge instructions.
After Delivery
(For Infant Born to a KNOWN HIV-Infected Mother)
Laboratory Evaluation (obtain parental verbal consent for HIV testing)
* If a low-risk infant has documented negative HIV DNA PCRs at >14 days and >4 weeks, can consider withholding PCP Prophylaxis. If prophylaxis initiated, discontinue TMP/SMX at 4 months of age if DNA PCR isnegative at 4 months and all previous PCRs negative.
Medication Dosing
TMP/SMX (Bactrim): 75mg/m2/dose TMP + SMX 325mg/m2/dose PO BID (6 weeks – 4 months)
-Prophylaxis should be given BID, 3 days a week (Monday - Tuesday - Wednesday)
-Suspension is 40mg TMP / 200mg SMX per 5 ml
-Screen for G6PD deficiency in African Americans before starting Bactrim
References
1. “Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1Transmission in the United States.” Perinatal HIV Guidelines Working Group. AIDSinfo Web site (http://AIDSinfo.nih.gov). Version July 31, 2012.
2. American Academy of Pediatrics and the Committee on Pediatric AIDS. Evaluation and Treatment of the Human
Immunodeficiency Virus-1-Exposed Infant. Pediatrics 2004; 114 (2): 497-505.
3. American Academy of Pediatrics. HIV. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: Report of the
Committee on Infectious Diseases. 28th Ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009.
Revised and Approved 12/2006, 05/2009, 01/2012, 02/2012, 08/2012, 07/2013
Division of Pediatric Infectious Diseases