Question | Discussion | References | CME Credit

Updated February 13, 2006

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

Author: Brenda J. Ross, MD

A 30-year old HIV-infected, multiparous female presents to Labor and Delivery in active labor. She has been taking zidovudine plus lamivudine (Combivir) plus nelfinavir (Viracept) beginning in week 12 of her pregnancy. Recent laboratory studies show her HIV RNA is less than 50 copies/ml and her CD4 count is 560 cells/mm3. Intravenous zidovudine (Retrovir) is started. Her labor progresses well, and she vaginally delivers a healthy female infant without complications. Within 48 hours of delivery a HIV DNA PCR is sent on the infant and the result is negative.

Which of the following would be most appropriate to tell the mother?

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.
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.