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Case 4: Management and Monitoring of Neonates Born to HIV-Infected Mothers

You answered:

A The test ordered was inappropriate and the results are meaningless. The infant should have been screened with an HIV antibody test instead of a HIV PCR test.

This answer is incorrect. Although the test was appropriate for diagnosing HIV in this setting, testing with HIV DNA PCR within the first 48 hours identifies only about 40% of HIV-infected neonates. Testing for HIV antibody during the neonatal period is inconclusive because maternal antibodies readily cross the placenta and it may take up to 18 months for those antibodies to clear.

Choose another answer:

B The appropriate test was performed. Based on these results the infant is not infected with HIV and no additional testing is necessary. The infant requires no medication at this time.
C The appropriate test was performed. Regardless of what the result shows, the infant does not need prophylaxis against Pneumocystis pneumonia since the mother’s CD4 count is greater than 200 cells/mm3.
D The appropriate test was sent, but additional HIV PCR testing will be necessary. In addition, the child should have an HIV antibody test performed at 18 months of age. The infant should receive 6 weeks of zidovudine, followed by prophylaxis against Pneumocystis pneumonia.

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