We commend Havens, Mofenson and the Committee on Pediatric AIDS for
their excellent and comprehensive articles, “HIV testing and prophylaxis
to prevent mother-to-child transmission in the United States” and
“Evaluation and management of the infant exposed to HIV-1 in the United
States.” Pediatricians should feel confident that these articles concisely
present the core information they need to provide state-of-the-art care
for HIV-exposed infants.
It is often assumed that HIV-exposed infants should be cared for by
pediatric HIV specialists, but this need not be the case. The vast
majority of infants born to HIV-infected pregnant women in the United
States will be at relatively low risk for transmission. Low risk infants
can be confidently cared for by general pediatricians or family physicians
who can monitor the infant during the 6 weeks of zidovudine therapy,
conduct several HIV tests, and possibly prescribe
trimethoprim/sulfamethoxazole for PCP prophylaxis as outlined in the
article. With the proper management, HIV can be definitively excluded in
uninfected infants by 4 months of age and the provider can proceed with
standard well child care. Families with a pre-existing tie to a generalist
will be able to maintain their therapeutic relationship during this
important bonding time with the new infant. In situations when the risk of
HIV transmission is elevated, however, infants are best managed in concert
with HIV-experienced providers, as the authors explain.
Our National Perinatal HIV Hotline (1-888-448-8765) can help
clinicians provide best quality care by offering direct access to experts
for clinical consultation, tailored to the needs of each caller. It is
free, confidential and available 24 hours a day. We assist providers with
the range of clinical questions from basic management of the low-risk
infant to advice on challenging cases. If callers would like consultation
closer to home, our Perinatal HIV Clinicians Network can help locate
resources in their area for one-time consultation, co-management or to
accept complete transfer of care. The Perinatal HIV Hotline and Clinicians
Network are funded by the Health Resources and Services Administration
AIDS Education and Training Centers (AETC) Program and have received
funding from the Centers for Disease Control and Prevention as part of the
National HIV/AIDS Clinicians’ Consultation Center in the University of
California at San Francisco General Hospital.
The authors of this letter have no conflicts of interest to disclose.
JESSICA FOGLER, M.D.
Director, Perinatal HIV Hotline
Assistant Clinical Professor, Family and Community Medicine
University of California San Francisco at San Francisco General Hospital
(415) 206-8592 (office)
jfogler@nccc.ucsf.edu
SHANNON WEBER, M.S.W.
Coordinator, Perinatal HIV Hotline
University of California San Francisco at San Francisco General Hospital
sweber@nccc.ucsf.edu
DEBORAH COHAN, M.D., M.P.H.
Associate Director, Perinatal HIV Hotline
Associate Professor, Obstetrics and Gynecology
University of California San Francisco at San Francisco General Hospital
cohand@obgyn.ucsf.edu
RONALD GOLDSCHMIDT, M.D.
Director, National HIV Clinicians’ Consultation Center (NCCC)
Professor of Family and Community Medicine
University of California San Francisco at San Francisco General Hospital
rgoldschmidt@nccc.ucsf.edu
Conflict of Interest:
None declared
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