HIV Guidelines

The incidence of Pediatric AIDS in the District of Columbia has declined dramatically with the increased use of antiretroviral therapies for HIV-positive pregnant women. Effective assessment, diagnosis, and treatment strategies enable providers to identify and respond to the important health needs of this special population.

Screening and Treatment of HIV-Infected and Pregnant Women

Hospitals, diagnostic and treatment centers, MCOs and birthing centers must provide HIV counseling and recommend voluntary HIV testing to all women in prenatal care.

Identification of maternal HIV status prior to or during pregnancy provides the opportunity to:

• Assess the most appropriate therapy for the woman
• Initiate treatment for the reduction of perinatal HIV transmission

See also CDC's Revised Recommendations for HIV Screening of Pregnant Women.

Perinatal HIV Transmission

• Maternal-infant transmission risk can be reduced by as much as two-thirds through the administration of zidovudine (ZDV), also know as AZT, to the HIV-positive pregnant woman during her pregnancy, during delivery, and to her infant immediately after birth
• Treatment of the HIV-infected pregnant woman requires careful coordination of maternal therapy while considering the mother's health status (including any pre-pregnancy medication regimen and the timing of her HIV diagnosis)

Screening and Treatment of HIV-Exposed Infants

The identification of HIV-exposed infants and the documentation of HIV infection are critical. All infants born to HIV-positive women will initially test ELISA positive due to maternal antibodies; most, however, are not infected Clinicians can reliably diagnose or exclude HIV infection in an exposed infant by 4 months of age The earlier the diagnosis of HIV infection, the better the prognosis; the provision of early appropriate care improves the child’s chances of a better quality of life The ability to exclude an HIV diagnosis provides important peace of mind for the families Infants born to HIV-seropositive mothers should be tested according to the Public Health Service Treatment Guidelines (See Appendices). See the Protocol for Infants Born to HIV-Seropositive Mothers.

Treatment of HIV-Infected Children

The identification and primary care of HIV-infected children should be provided in medical facilities that have the capacity to provide comprehensive, family-centered primary health care onsite and can refer to sub-specialty services as needed.

• A diagnosis of HIV infection should be reported in person, with support staff available
• Care for mother and child should be coordinated (e.g., scheduling several medical appointments on the same day; coordinating treatment plans)
• Support services (nutrition, mental health, case management, childcare, and health education) can enhance a family's ability to manage this as well as most chronic health conditions

Children may be HIV-infected without becoming symptomatic for years; comprehensive, routine, and frequent monitoring is essential.

• Consult with or refer to a facility offering comprehensive HIV care at the time of initial diagnosis
• Work closely with an HIV specialist in the development and ongoing assessment of a medical regimen/treatment plan
• Support the family's ability to adhere to the treatment plan

Early anti-retroviral therapy with several drugs is recommended at this time for all infected children less than 1 year of age and for a majority of older children.

The assessment and medical management of HIV-infected infants, children, and adolescents should include:

• An explanation of HIV transmission and the importance of universal precautions
• A general review of the medical care of HIV-infected children and preventive strategies (e.g., good nutrition, medication administration, surveillance for infections, pneumocystis carinii pneumonia (PCP) prophylaxis, immunizations, and guidelines on when to call the doctor)
• A review of HIV confidentiality and disclosure issues (e.g., identification of persons in the family who are aware of the diagnosis, the status of disclosure of the diagnosis to the child, school notification concerns, and signing of appropriate releases)
• A review of the child's health status and CDC classification, including the AIDS diagnosis (based on CDC's 1994 Revised Classification System for HIV Infection in Children Less Than 13 Years of Age)
• A review of available treatments, the pros and cons of clinical trials, and the child's current treatment plan

Note:

It is essential for families, children, and adolescents to be partners in the discussion of treatment options and the development of a plan.

Refer to the HIV/AIDS Treatment Information Service’s Web site for the most recent and regularly updated guidelines on anti-retroviral therapy in children, adolescents, and adults.

See a list of HIV Treatment Sites in Washington, DC and Metropolitan Area.