(If > 50 copies/ml, consider whether birth plan may need amended and discuss with consultant as a matter of urgency).Post exposure prophylaxis (PEP) should be commenced within 4 hours of deliveryEnsure follow up appointment at six weeks of age (sooner for higher risk or breast fed babies)Dr Conor Doherty – Royal Hospital for Children, Glasgow
Some Panel members opt to discontinue additional medications if birth nucleic acid test (NAT) results are negative, while others would continue presumptive HIV therapy for 2 to 6 weeks depending on the risk of HIV transmission. Management of Medication Toxicity or Intolerance In the IMPAACT P1115 study, 54 infants with HIV initiated presumptive HIV therapy between 0.4 and 40 hours of life. An additional virologic test should be performed 2 to 4 weeks after discontinuing presumptive HIV therapy (see Newborn prophylaxis with ZDV has been associated with only minimal toxicity, primarily transient hematologic toxicity (mainly anemia), which generally resolves by age 12 weeks (see Other than ZDV, 3TC is the NRTI with the most clinical experience for neonatal prophylaxis. What to Start Clinicians should be aware of their state laws, as not all states allow HIV testing in infants without parental consent.A nursing mother who is suspected of having HIV based on an initial positive antibody or antibody/antigen test result should stop breastfeeding until HIV is confirmed or ruled out. Post-natal care 13 6.1. Risk assessment 15 7.2. It is very important that the mother understands the importance of good compliance with the treatment, and that she is advised to seek help early if the baby does not tolerate the medication or becomes unwell in any way.Arrangements should be made for review at 6 (or 2, if breast fed) weeks of age, and the parents informed that blood tests will be repeated at this visit. Nucleoside and Nucleotide Analogue Reverse Transcriptase Inhibitors (NRTIs) Most babies born to mothers with HIV in GG&C are followed up in the Princess Royal Maternity in Dr Mactier / Dr Powls clinicRemember to check if the HIV status of any siblings has been checked; if not, then refer to Drs. Zidovudine. Register … Appendix B: Acronyms Prophylaxis. The anti-HIV medicines are known as antiretrovirals. Fixed-Dose Combinations By continuing to browse this site, you agree to its use of cookies as described in our I have read and accept the Wiley Online Library Terms and Conditions of Use The support of a health visitor and/or lactation expert should be sought. The brief version is a compilation of the tables and boxed recommendations.Last Updated: April 14, 2020; Last Reviewed: April 14, 2020General Considerations for Antiretroviral Management of Newborns Exposed to HIV or Born with HIVAll newborns with perinatal exposure to HIV should receive antiretroviral (ARV) drugs during the neonatal period to reduce the risk of perinatal HIV transmission, with selection of the appropriate ARV regimen guided by the level of transmission risk. Higher maternal viral load, especially in late pregnancy, correlates with higher risk of transmission. should immediately initiate presumptive HIV therapy This decision will be influenced by the presence of ruptured membranes. Levels of 17-hydroxyprogesterone were greater in newborns who were also exposed to LPV/r On the basis of these and other post-marketing reports of cardiac toxicity (including complete atrioventricular block, bradycardia, and cardiomyopathy), lactic acidosis, acute renal failure, adrenal dysfunction, central nervous system depression, respiratory complications leading to death, and metabolic toxicity, Newborns with prenatal ZDV exposure had significantly worse hematological values at birth, with lower levels of hemoglobin (14.3 g/dl vs. 16.2 g/dl, Please check your email for instructions on resetting your password. Non-Nucleoside Analogue Reverse Transcriptase Inhibitors (NNRTIs) BHIVA guidelines recommend that mothers who agree to formula feed should be offered lactation suppression; please ensure that this has been considered by the obstetric/midwifery team.NB. Entry and Fusion Inhibitors Entry and Fusion Inhibitors In term infants UGT activity is depressed at birth but quickly increases during the first few weeks of life, quadrupling Zidovudine clearance in the first month of life. Volume of ZDV 10 mg/mL Oral Syrup Twice Daily
coincident with the first repeat viral load.As per current BHIVA (British HIV Association) guidelines (2018):See local monograph for advice in regards to rounding of dosesIf the mother has been taking nevirapine antenatally, for 3 or more days immediately prior to delivery, the infant’s liver enzymes will already be induced and he/she should be commenced on the higher dose and continued on this dose for two weeks.See monograph for Raltegrivir once daily starting dose, which is dependent on both gestation and birth weightNote that treatment regimen may need to be adjusted if the mother has a history of multiple antiretroviral therapy exposure and resistance.