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

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You answered:

	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.

This answer is incorrect. Although the appropriate test was ordered to diagnose HIV in this setting, the HIV DNA PCR assay identifies only about 40% of HIV-infected neonates within the first 48 hours after birth. Repeat HIV DNA PCR testing at 14 and 28 days after birth markedly improves the diagnostic yield in the neonate. Therefore, additional testing is necessary. In addition, it is the standard of care to treat HIV exposed neonates with 6 weeks of zidovudine followed by prophylaxis against Pneumocystis pneumonia.

Choose another answer:

	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.
	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.
	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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