This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years by the authoring body, at which time a recommendation is made that the policy be retired, revised, or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation, or retires a statement, the current policy remains in effect.

Human immunodeficiency virus-1(HIV-1)

Counseling
Evaluation
Management
Prevention
Treatment

Family Practice
Infectious Diseases
Obstetrics and Gynecology
Pediatrics
Preventive Medicine

Physicians

• To provide recommendations to the pediatrician in the prevention of mother-to-child transmission of human immunodeficiency virus-1 (HIV-1)
• To provide recommendations to the pediatrician for the care of HIV-1 exposed infants

• Pregnant women identified as having human immunodeficiency virus-1 (HIV-1)
• Infants exposed to or infected with HIV-1

• Risk and rate of mother-to-child transmission of perinatal human immunodeficiency virus type 1 (HIV-1) infection
• Congenital and perinatal infections associated with HIV-1 infection, such as Pneumocystis pneumonia and tuberculosis
• Sensitivity and specificity of screening and diagnostic tests used to detect HIV-1 infection
• Short and long-term toxicities of antiretroviral exposure

Searches of Electronic Databases

Not stated

Not stated

Not stated

Not applicable

Review

Not stated

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Peer Review

Not stated

1. Whenever possible, maternal human immunodeficiency virus-1(HIV-1) infection should be identified before or during pregnancy, because this allows for earlier initiation of care for the mother and for more effective interventions to prevent perinatal transmission.
2. If the maternal HIV-1 infection status is unknown at the time of the infant’s birth, then HIV-1 testing of the mother or the infant is recommended with maternal consent and with results available within 24 hours of birth. The expedited enzyme immunoassay (EIA) and rapid HIV-1 test are screening tests that may be used in this setting.
3. If the test result for HIV-1 is positive, prophylactic antiretroviral therapy should be started promptly in the infant and confirmatory HIV-1 testing should be performed.
4. HIV-1–infected mothers should not breastfeed their infants and should be educated about safe alternatives (Read, 2003)
5. Maternal health information should be reviewed to determine if the HIV-1–exposed infant may have been exposed to maternal coinfections including tuberculosis (TB), syphilis, toxoplasmosis, hepatitis B or C, cytomegalovirus, and herpes simplex virus. Diagnostic testing and treatment of the infant are based on maternal findings.
6. Pediatricians should provide counseling to parents and caregivers of HIV-1–exposed infants about HIV-1 infection, including anticipatory guidance on the course of illness, infection-control measures, care of the infant, diagnostic tests, and potential drug toxicity.
7. All HIV-1–exposed infants should undergo virologic testing for HIV-1 at birth, at 4 to 7 weeks of age, and again at 8 to 16 weeks of age to reasonably exclude HIV-1 infection as early as possible. If any test result is positive, the test should be repeated immediately for confirmation. If all test results are negative, the infant should have serologic testing repeated at 12 months of age or older to document disappearance of the HIV-1 antibody, which definitively excludes HIV-1 infection.
8. All infants exposed to antiretroviral agents in utero or as infants should be monitored for short and long-term drug toxicity.
9. Prophylaxis for Pneumocystis pneumonia (PCP) should be started at 4 to 6 weeks of age in HIV-1–exposed infants in whom infection has not been excluded. PCP prophylaxis may be discontinued when HIV-1 infection has been reasonably excluded.
10. Immunizations and TB screening should be provided for HIV-1–exposed infants in accordance with national guidelines. In the United States, immunization guidelines are established by the AAP, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and the American Academy of Family Physicians; in Canada, guidelines are established by the National Advisory Committee for Immunizations.
11. HIV-1 testing should be offered and recommended to family members.
12. The practitioner providing care for the HIV-1– exposed or HIV-1–infected infant should consult with a pediatric HIV-1 specialist and, if the HIV-1–infected mother is an adolescent, also consult with a practitioner familiar with the care of adolescents.

None provided

The type of evidence supporting each recommendation is not specifically stated.

• Effective prevention of transmission from mother-to-child of human immunodeficiency virus-1 (HIV-1)
• Effective care of the HIV-1 exposed infant
• Early identification of the HIV-1 infected infant
• Prevention of congenital and perinatal infections associated with HIV-1 infection, such as Pneumocystis pneumonia and tuberculosis

• Some studies suggest that combination antiretroviral therapy during pregnancy increases the risk of preterm birth and other adverse outcomes of pregnancy.
• The most common short-term adverse consequence with zidovudine (ZDV) prophylaxis is anemia.
• Human immunodeficiency virus-1 (HIV-1) virologic testing may result in false-positive or false-negative results.

Bacillus Calmette-Guerin (BCG) vaccine is contraindicated in infants who are human immunodeficiency virus-1(HIV-1) infected or are of unknown HIV-1 status

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

An implementation strategy was not provided.

Getting Better
Living with Illness
Staying Healthy

Effectiveness
Patient-centeredness

Not applicable: The guideline was not adapted from another source.

2004 Aug

American Academy of Pediatrics - Medical Specialty Society
Canadian Paediatric Society - Medical Specialty Society

American Academy of Pediatrics

Committee on Pediatric AIDS, 2002-2003

Canadian Paediatric Society Infectious Diseases and Immunization Committee

Committee on Pediatric AIDS, 2002-2003 Members: Mark W. Kline, MD (Chairperson); Robert J. Boyle, MD; Donna C. Futterman, MD; Peter L. Havens, MD; Lisa M. Henry-Reid, MD; Susan M. King, MD, MSc; Jennifer S. Read, MD, MS, MPH; Diane W. Wara, MD

Liaisons: Mary G. Fowler, MD, MPH, Centers for Disease Control and Prevention; Lynne M. Mofenson, MD, National Institute of Child Health and Human Development

Staff: E. Jeanne Lindros, MPH

Canadian Paediatric Society Infectious Diseases and Immunization Committee Members: Upton Allen, Toronto, Ontario, Canada; H. Dele Davies, East Lansing, MI; Simon Richard Dobson, Vancouver, British Columbia, Canada; Joanne Embree (Chairperson), Winnipeg, Manitoba, Canada; Joanne Langley, Halifax, Nova Scotia, Canada; Dorothy Moore, Montreal, Quebec, Canada; Gary Pekeles, Board Representative, Montreal, Quebec, Canada

Consultants: Gilles Deluge, Saint-Laurent, Quebec, Canada; Noni MacDonald, Halifax, Nova Scotia, Canada

Liaisons: Scott Halperin, Halifax, Nova Scotia, Canada; Susan King, Toronto, Ontario, Canada; Monica Naus, Vancouver, British Columbia, Canada; Larry Pickering, Atlanta, GA

Not stated

This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years by the authoring body, at which time a recommendation is made that the policy be retired, revised, or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation, or retires a statement, the current policy remains in effect.

None available

None available

This NGC summary was completed by ECRI on September 23, 2004. The information was verified by the guideline developer on November 3, 2004. This summary was updated on January 21, 2005, following the release of a public health advisory from the U.S. Food and Drug Administration regarding the use of nevirapine.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.