3.30 MB - Academy of Medicine of Malaysia

MANAGEMENT OF HIV INFECTION IN CHILDREN
injecting drug users (IDUs) found a predominance of subtype B in more than
90% of the subjects. 51, Level 8 However a more recent study in a similar population
(i.e. IDUs) demonstrated that subtype B was present in 50.0% followed by
52, Level 8
CRF01_AE/B recombinant in 41.7%.
HIV RNA assays detect extracellular viral RNA in the plasma and are as
sensitive and specific as HIV DNA PCR for early diagnosis of HIV infection
in HIV-exposed infants. 53, Level 6; 54, Level 6; 46, Level 9 However no HIV RNA PCR test is
55, Level 9
currently licensed in Malaysia for use in diagnosing infection.
The use of the currently approved HIV p24 antigen assay is not recommended
for infant diagnosis because of its lower sensitivity compared to other virologic
46, Level 9; 48, Level 9; 56, Level 8
tests.
In general, HIV-1 DNA PCR assay is the preferred diagnostic test. The birth
specimen must be a neonatal, not a cord blood sample. 46, Level 9 The reference
laboratory (Institute for Medical Research) requests that the first sample
should be sent with mother's sample for antibody re-testing.
Recommendation for investigations at birth
A Full Blood Count (FBC) should be performed on the newborn as a
baseline evaluation before administration of zidovudine and repeated at
6 weeks after completion of the zidovudine regimen. If abnormal, repeat
measurement should be performed at age 12 weeks. (Grade B)
Infants who have anaemia at birth or who are born prematurely
warrant more intensive monitoring of FBC. (Grade C)
At the time of birth, review maternal health information to determine if
the infant may have been exposed to maternal co-infections such as
tuberculosis, syphilis, toxoplasmosis, cytomegalovirus, Herpes simplex
and Hepatitis B and C infections. Diagnostic testing and treatment of the
infant are based on maternal and infant findings. (Grade C)
HIV DNA PCR test should be carried out at 14-21 days of age (and at
subsequent intervals - see Section 2.7) (Grade C)
2.4 ADVICE AND COUNSELLING
Counselling and support to address the numerous possible problems faced
by the HIV positive mother are a necessary part of management. Possible
problem areas that should be addressed include social, family, domestic
violence, financial status and unemployment among others.
New parents of an HIV exposed infant would also require information,
support and advice on medical care for the infant. Such counselling should
9