Review Question - QID 101522

This infant presents with thrush and chronic diarrhea, which are suggestive of neonatal HIV infection in the context of the mother's social history. Zidovudine (ZDT, formerly AZT) is the prototype nucleoside reverse transcriptase inhibitor used in maternal HIV prophylaxis during pregnancy.

HIV presents in the neonate with recurrent infection, recurrent diarrhea, and leukopenia. According to the CDC, in the United States, without antiretroviral therapy, approximately 25% of pregnant women infected with HIV will transmit the virus to their child. Since the advent of maternal antiretroviral therapy in 1992, there has been a >96% reduction in new cases of perinatal AIDS, now at about 50 cases annually, and fewer than 300 annual perinatal HIV transmissions. ZDT prophylaxis should continue in the neonate following birth for 6 weeks.

Krist et al. review management of newborns whose mothers are HIV-positive. Maternal antiretroviral therapy beginning at 14 weeks and continuing throughout labor, as well as elective Caesarian section, can decrease the risk of vertical transmission from mother to child. Viral loads should be followed in the infant, even if negative, for 18 months, as prompt intervention to prevent infection can be life-saving. Pneumocystis carinii pneumonia is often the presenting illness in infants. PCP prophylaxis may be initiated in the infant at six weeks of age.

A 2007 review by Suksomboon et al. summarizes the recommendations for maternal HIV prophylaxis in pregnancy: zidovudine alone or in combination with lamivudine and nevirapine. This regimen may reduce infant death.

Figure A shows oral thrush, a common sign of neonatal HIV infection.
Illustration A shows the dosing and timing of recommended HIV prophylaxis for infants of different gestational age as well as for infants whose mothers did not take any HIV prophylaxis medications.

Incorrect answers:
Answer 1: Pregnant women should take folic acid to prevent spina bifida in the neonate. This patient does not present with spina bifida.
Answer 2: Acyclovir is used for the treatment of DNA viruses such as the herpes viruses.
Answer 4: Ribavirin is used for the treatment of Hepatitis C.
Answer 5: Zanamivir is an intranasal neuraminidase inhibitor used for treatment of influenza.