Monitoring a Baby Born When Mom Has Hiv

Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and causes acquired immunodeficiency syndrome (AIDS).

• Human immunodeficiency virus (HIV) infection is caused by the viruses HIV-i and HIV-2 and, in young children, is typically acquired from the female parent at the time of nascency.

• Signs of infection include slowed growth, enlargement of lymph nodes in several areas of the body, developmental delay, recurring bacterial infections, and lung inflammation.

• The diagnosis is based on special blood tests.

• Children who receive anti-HIV drug therapy (called antiretroviral therapy or ART) can alive to adulthood.

• Infected mothers can prevent transmitting the infection to their newborn by taking antiretroviral therapy, feeding their newborn formula rather than breast milk, and, for some women, undergoing a cesarean commitment.

• Children are treated with the aforementioned drugs as adults.

In that location are two human immunodeficiency viruses:

• HIV-1

• HIV-ii

Infection with HIV-1 is by far more mutual than infection with HIV-2 in almost all geographic areas. Both progressively destroy certain types of white blood cells called lymphocytes Lymphocytes I of the body's lines of defense (allowed system) involves white blood cells (leukocytes) that travel through the bloodstream and into tissues, searching for and attacking microorganisms and... read more , which are an important part of the torso's immune defenses. When these lymphocytes are destroyed, the body becomes susceptible to assail by many other infectious organisms. Many of the symptoms and complications of HIV infection, including death, are the result of these other infections and not of the HIV infection itself. HIV infection may lead to various troublesome infections with organisms that do not ordinarily infect salubrious people. These are chosen opportunistic infections because they take advantage of a weakened immune system. Opportunistic infections may effect from viruses, parasites, fungi, and, perhaps more than often than in adults, sometimes bacteria.

Acquired immunodeficiency syndrome (AIDS) is the nigh severe form of HIV infection. A child with HIV infection is considered to have AIDS when at least ane complicating illness develops or when there is a significant decline in the torso'southward ability to defend itself from infection.

Only well-nigh 1% of the people infected with HIV in the United states have been diagnosed equally children or young adolescents. HIV infection in children has now become rare, because of greater testing and handling of pregnant women infected with HIV. Although about 9,000 cases of HIV infection were reported in children and young adolescents betwixt 1983 and 2015, in 2018, fewer than 100 new cases were diagnosed in children under thirteen years of historic period.

Although the number of HIV-infected infants and children living in the U.s.a. continues to decrease, the number of HIV-infected adolescents and young adults is increasing. The number is increasing because children who were infected every bit infants are surviving longer and new cases are developing in adolescents and young adults, particularly in young men who take sex with men.

Worldwide, HIV is a much more common problem among children. Most 1.7 million children have HIV infection. Each year, nearly 160,000 more children are infected and virtually 100,000 children die. In the past few years, new programs created to deliver antiretroviral therapy (ART) to pregnant women and children have reduced the annual number of new childhood infections and childhood deaths by 33 to 50%. Notwithstanding, infected children still practise not receive ART nearly every bit often as adults.

HIV is most commonly transmitted to children past

• An infected mother before birth or during birth

• Subsequently birth through the female parent's milk

In immature children, HIV infection is most always acquired from the mother. More than 95% of HIV-infected children in the U.s. acquired the infection from their female parent, either before or effectually the time of birth (called vertical transmission or mother-to-child transmission). Well-nigh of the remaining children at present living with AIDS acquired the infection from sexual practice, including, rarely, sexual abuse. Because of improved condom measures regarding screening of blood and blood products, in recent years about no infections have resulted from the employ of claret and blood products in the U.s., Canada, or Western Europe.

Experts are not sure how many HIV-infected women requite birth each year in the United States, just the Centers for Illness Command and Prevention (CDC) estimate is nigh 5,000. Without preventive measures, 25 to 33% of them would transmit the infection to their baby. Manual often takes place during labor and commitment.

The risk of manual is highest among mothers who

• Acquire HIV infection during pregnancy or while breastfeeding

• Are severely ill

• Have more than virus in their body

Nevertheless, transmission has declined significantly in the United States from about 25% in 1991 to less than 1% in 2018. Mother-to-kid transmission has been reduced because of an intensive effort to test and care for infected pregnant women during both pregnancy and delivery.

The virus also can be transmitted in breast milk. About 12 to 14% of infants not infected at nascency acquire HIV infection if they breastfeed from an HIV-infected mother. Virtually often, transmission occurs in the first few weeks or months of life only may occur later. Transmission past breastfeeding is more likely in mothers who take a high level of virus in their trunk, including those who acquired the infection during the time period in which they were breastfeeding their infant.

• Having unprotected sexual intercourse

• Sharing infected needles

Heterosexual and homosexual adolescents are at increased risk of HIV infection if they have unprotected sex activity. Adolescents who share infected needles while injecting drugs are too at increased gamble.

In very rare cases, HIV has been transmitted past contact with infected blood on the skin. In almost all such cases, the skin surface was cleaved by scrapes or open sores. Although saliva may contain the virus, transmission of infection by coughing, kissing, or biting has never been confirmed.

HIV is non transmitted through

• Food

• Water

• Household articles

• Social contact in a home, workplace, or school

Children built-in with HIV infection rarely have symptoms for the first few months even if they have not received antiretroviral therapy (ART). If the children remain untreated, only about 20% develop problems during the starting time or 2nd year of life. Such children probably became infected well before birth. For the remaining 80% of untreated children, issues may non announced until historic period three or even later age v. Such children probably became infected at or virtually birth.

Common symptoms of HIV infection in untreated children include

• Slowed growth and a delay of maturation

• Enlargement of lymph nodes in several areas of the torso

• Recurring diarrhea

• Lung infections

• Enlargement of the spleen or liver

• Fungal infection of the oral fissure (thrush)

Sometimes children accept repeated episodes of bacterial infections, such as a eye ear infection (otitis media), sinusitis, bacteria in the blood (bacteremia), or pneumonia.

A diversity of symptoms and complications can appear every bit the child's immune organization deteriorates. Almost ane third of HIV-infected children develop lung inflammation (lymphoid interstitial pneumonitis), with coughing and difficulty breathing.

In a meaning number of HIV-infected children, progressive brain impairment prevents or delays developmental milestones, such as walking and talking. These children as well may have impaired intelligence and a head that is pocket-size in relation to their body size. Up to 20% of untreated infected children progressively lose social and language skills and muscle control. They may become partially paralyzed or unsteady on their anxiety, or their muscles may become somewhat rigid.

With Art, children with HIV infection exercise non necessarily develop any symptoms of HIV infection. Art has significantly changed the way HIV infection manifests in children. Although bacterial pneumonia and other bacterial infections (such equally bacteremia and recurring otitis media) occur slightly more often in HIV-infected children, opportunistic infections and growth failure are much less frequent than in the era before ART.

Although ART clearly lessens the effects of brain and spinal string disorders, there seems to be an increased rate of behavioral, developmental, and cognitive problems in treated HIV-infected children. It is unclear whether these problems are caused past HIV infection itself, the drugs used to treat HIV, or other biologic, psychologic, and social factors that are mutual among HIV-infected children.

Because ART has immune children and adults to survive for many years, more people are developing long-term complications of HIV infection. These complications include obesity, heart disease, diabetes, and kidney illness. These complications appear to be related both to HIV infection itself and to the effects of certain ART drugs.

• Prenatal screening

• Blood tests

• Subsequently diagnosis, frequent monitoring

The diagnosis of HIV infection in children begins with the identification of HIV infection in pregnant women through routine prenatal screening of blood. Rapid tests for HIV can exist done while women are in labor and delivery suites at the hospital. These tests can provide results in minutes to hours.

Testing using NATs should be washed at frequent intervals, typically in the start two weeks of life, at virtually 1 calendar month of age, and between iv months and 6 months of age. Such frequent testing identifies most HIV-infected infants past 6 months of age. Some infants who take a very loftier risk of developing HIV may be tested more frequently.

All infants should be tested if they are born to mothers who

• Have HIV infection

• Are at risk of HIV infection

The CD4 count decreases as HIV infection worsens. If the CD4 count is low, children are more than likely to develop serious infections and other complications of HIV, such as sure cancers.

The viral load increases as HIV infection worsens. Viral load helps predict how fast the CD4 count is likely to subtract over the next few years.

The CD4 count and viral load assistance doctors decide how soon to kickoff antiretroviral drugs, what effects treatment is likely to have, and whether other drugs may exist needed to prevent complicating infections.

Earlier antiretroviral therapy (Fine art), 10 to 15% of children from industrialized countries and peradventure 50 to eighty% of children from developing countries died earlier iv years of historic period. Today, with Fine art, nearly children born with HIV infection alive well into adulthood. Increasing numbers of these young adults who were infected at nascence have given nascency to or fathered their own children.

All the same, if opportunistic infections occur, particularly Pneumocystis pneumonia, the prognosis is poor unless ART is successful. Pneumocystis pneumonia causes death in 5 to 40% of treated children and in about 100% of untreated children. The prognosis is also poor for children in whom the virus is detected early (within the first week of life) or who develop symptoms in the first yr of life.

It is unknown whether HIV infection itself or ART given to HIV-infected children during critical periods of growth and development will cause additional side effects that appear subsequently in life. Notwithstanding, and so far, no such side effects have been noted in children infected at or before nativity who were treated with ART and who are now young adults.

Because of the way HIV remains subconscious within people'south cells, drugs exercise not completely eliminate the virus from the body. Fifty-fifty when tests do not observe the virus, some viruses remain within cells. In one case, a child who was built-in to an untreated, HIV-infected mother was given high doses of ART. Although the Art was unintentionally interrupted when the child was xv months of age, at 24 months of historic period, doctors were however not able to detect reproducing (replicating) HIV in the child. All the same, doctors were able to detect the virus later. Research studies are underway to find out whether giving high doses of ART to suppress the virus, fifty-fifty if but for a short fourth dimension, leads to ameliorate wellness. Doctors exercise recommend that people do not interrupt their Art.

To date, there is no cure for HIV infection, and it is not notwithstanding known if a cure is possible. What is known, however, is that HIV infection is a treatable infection and that long-term survival is possible if effective ART is given.

Current preventive therapy for infected pregnant women is highly effective at minimizing transmission. HIV-infected meaning women should begin antiretroviral therapy (ART) by mouth. Ideally, Art should begin every bit soon as HIV infection is diagnosed and women are prepare to follow the therapy equally directed. HIV-infected pregnant women who are already on Fine art should continue the therapy throughout the pregnancy. HIV-infected women should also go along Art when trying to get pregnant.

In addition to maternal Art, the antiretroviral drug zidovudine (ZDV) is often given by vein (intravenously) during labor and delivery to the mother. ZDV is and so given to the HIV-exposed newborn by oral fissure twice a day for the first four to half-dozen weeks of life (sometimes along with additional antiviral drugs for certain newborns at greater risk of acquiring HIV infection). Treatment of mothers and children in this way reduces the rate of transmission from 25% to 1% or less. Also, cesarean delivery Cesarean Delivery Cesarean delivery is surgical commitment of a baby by incision through a woman's abdomen and uterus. In the The states, upwards to thirty% of deliveries are cesarean. Doctors use a cesarean delivery... read more (c-department) done before labor begins may reduce the newborn'southward risk of acquiring HIV infection. Doctors may recommend cesarean delivery for women whose infection was not well controlled by Art. After delivery, Art is connected for all HIV-infected women.

In countries where skilful infant formulas and clean h2o are readily available, HIV-infected mothers should bottle-feed formula to their infants and should exist advised never to breastfeed their infants or donate their chest milk to milk banks. In countries where the risks of undernutrition or infectious diarrhea resulting from using unclean water to feed infants or set up formula are high, the benefits of breastfeeding outweigh the risk of HIV transmission. In these developing countries, HIV-infected mothers should continue to breastfeed for the first half dozen months of the babe's life and then chop-chop wean the infant to nutrient. Often their infants are given ART throughout the period of breastfeeding. HIV-infected mothers should non prechew (premasticate) food for infants.

Because a kid's HIV status may not be known, all schools and day care centers should adopt special procedures for handling accidents, such as nosebleeds, and for cleaning and disinfecting surfaces contaminated with blood. During cleanup, personnel are advised to avoid having their pare come up in contact with blood. Latex gloves should be routinely available, and easily should be washed after the gloves are removed. Contaminated surfaces should exist cleaned and disinfected with a freshly prepared bleach solution containing 1 part of household bleach to x to 100 parts of h2o. These practices (called universal precautions) are followed not only for children with HIV infection simply for all children and in all situations involving blood.

Taking an antiretroviral drug before existence exposed to HIV tin can reduce the run a risk of HIV infection. Such preventive handling is called preexposure prophylaxis (PrEP). PrEP is most effective if people take the drug every mean solar day, only information technology can be expensive. PrEP is now recommended for people who accept a high risk of becoming infected, such every bit people who have a partner who is infected with HIV, men who accept sex with men, and transgender people. Older adolescents at risk may also receive PrEP, but issues of confidentiality and toll are more complex than with developed PrEP.

Children with a significantly impaired allowed system as well are given azithromycin or clarithromycin to prevent Mycobacterium avium circuitous infection. Rifabutin is an alternative drug.

• Drugs

• Ongoing monitoring

• Encouraging adherence to handling

• Two nucleoside reverse transcriptase inhibitors (NRTIs) plus

• A protease inhibitor or an integrase inhibitor

Rarely, a nonnucleoside reverse transcriptase inhibitor is given with two NRTIs.

Notwithstanding, non all of the drugs used for older children, adolescents, and adults are bachelor to young children, in part because some are not available in liquid course.

In full general, children develop the same types of side effects equally adults only usually at a much lower rate. However, the side effects of drugs may as well limit the handling.

Increased numbers of virus in the claret may be a sign that the virus is developing resistance to the drugs or that the child is non taking the drugs. In either case, the doctor may need to modify the drugs. To monitor a kid'southward progress, the doctor examines the child and does blood tests on the child at 3- to 4-month intervals. Other blood tests and urine tests are done at six- to 12-month intervals.

Adherence (taking drug therapy every bit directed) to prescribed ART dosing schedules is extremely of import. If children have ART drugs less ofttimes than they are supposed to, the HIV in their organisation can rapidly go permanently resistant to one or more of the drugs. Yet, information technology may be difficult for parents and children to follow and adhere to complicated drug regimens, which tin can limit the effectiveness of therapy. To simplify regimens and amend adherence, tablets containing three or more drugs may be given. These tablets may demand to be taken simply in one case or twice a day. The liquid forms of drugs are now improve-tasting, which may improve adherence.

Adherence to Art may be more difficult for adolescents than for younger children. Adolescents also have difficulty adhering to treatment regimens for other chronic diseases such as diabetes and asthma. Adolescents desire to exist like their peers and tin experience gear up apart by their illness. Skipping or stopping treatment may exist a manner for them to deny having an illness. Boosted bug that may complicate treatment and reduce adherence in adolescents include

• Low cocky-esteem

• A chaotic and unstructured lifestyle

• Fear of being singled out because of disease

• Sometimes a lack of family support

Some vaccines containing alive bacteria, such as bacille Calmette-Guérin (which is used to foreclose tuberculosis in some countries outside the Us), or live viruses, such every bit the oral polio virus, varicella, and measles-mumps-rubella, can cause a severe or fatal illness in children with HIV whose immune organization is very dumb. However, the alive measles-mumps-rubella vaccine Measles, Mumps, and Rubella Vaccine The measles, mumps, and rubella (MMR) vaccine is a combination vaccine that helps protect against these three serious viral infections. The vaccine contains alive simply weakened measles, mumps... read more and live varicella vaccine Varicella Vaccine The varicella vaccine helps protect against chickenpox (varicella), a very contagious infection acquired by the varicella-zoster virus. It causes an itchy rash that looks like small blisters with... read more are recommended for children with HIV infection whose immune system is non severely impaired.

Withal, the effectiveness of any vaccination is less in children with HIV infection. HIV-infected children with very low CD4+ prison cell counts are considered susceptible to vaccine-preventable diseases when they are exposed to i (such as measles, tetanus, or varicella) regardless of whether they have received the vaccine for that disease and may be given immune globulin past vein (intravenously). Intravenous allowed globulin or immediate vaccination with measles-mumps-rubella vaccine also should be considered for whatsoever nonimmunized household member who is exposed to measles.

For children who need foster care, kid care, or schooling, a doc can help assess the child's risk of exposure to infectious diseases. In general, transmission of infections, such as chickenpox, to the HIV-infected kid (or to any kid with an impaired allowed system) is more of a danger than is transmission of HIV from that child to others. However, a young child with HIV infection who has open up skin sores or who engages in potentially unsafe beliefs, such as bitter, should not attend child care.

HIV-infected children should participate in as many routine childhood activities as their physical condition allows. Interaction with other children enhances social development and cocky-esteem. Because of the stigma associated with the disease, the routine use of universal precautions in schools and day care centers, and the fact that transmission of the infection to other children is extremely unlikely, there is no demand for anyone other than the parents, the md, and perhaps the school nurse to be aware of the kid's HIV condition.

Every bit a child's condition worsens, treatment is best given in the least restrictive surroundings possible. If dwelling house health care and social services are available, the child can spend more fourth dimension at home rather than in a hospital.

One time they reach a sure historic period (typically 18 to 21 years), HIV-infected adolescents will transition from pediatric intendance to adult care. The developed health care model is quite dissimilar, and adolescents should non merely be referred to an adult clinic or office without additional planning.

Pediatric wellness intendance tends to be family-centered, and the care team includes a multidisciplinary team of physicians, nurses, social workers, and mental health professionals. Adolescents infected at nascence may accept been cared for by such a team for their entire life. In contrast, the typical adult wellness intendance model tends to be individual-centered, and the health intendance practitioners involved may exist located in split offices requiring multiple visits. Health care practitioners at developed care clinics and offices are often managing loftier patient volumes, and the consequences of lateness or missed appointments (which may exist more mutual among adolescents) are stricter.

Planning transition over several months and having adolescents have discussions or joint visits with the pediatric and adult wellness intendance practitioners can pb to a smoother and more successful transition. (Run into also the World Health Organization's transition resource).

• Catastrophe the HIV Epidemic: Tips to assistance eliminate new HIV infections from the Centers for Disease Control and Prevention (CDC)

• Preexposure Prophylaxis (PrEP): Explanation of drugs that make up the PrEP pills from the American Sexual Health Association

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