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

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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.

This answer is correct. Specific viral assays (HIV culture, HIV DNA PCR, or HIV RNA tests) should be performed in this setting, since maternal antibodies readily cross the placenta and can generate a false-positive HIV antibody test in the infant. A single HIV DNA PCR test at birth, however, has a sensitivity of only about 40%. The yield improves to greater than 90% if repeat testing is performed at day 14 and 28. Regardless of the results of direct virologic tests at birth, all neonates born to HIV-infected mothers should receive 6 weeks of zidovudine, followed by prophylaxis against Pneumocystis pneumonia. At 18 months, an HIV antibody test should be performed, since by that time, the infant should have cleared the maternal HIV antibodies from its blood.


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