Sample Clinical Scenario for Evaluation and Treatment of the Infant Exposed to HIV-1 in the United States

Timing (Infant Age)ActionComment
BirthHistory and physical examination; assess risk of other infections; start ARV prophylaxis; check hemoglobin levelHIV-1 NAATa is not needed at birth in this setting, because risk of in utero transmission is low; for infant whose mother had high virus load during pregnancy, consider HIV-1 NAAT at this time
14 dHIV-1 NAATIf result is negative, repeat at 4 wkb,c
4 wkHIV-1 NAATIf result is negative, HIV-1 infection is presumptively excluded (given previous negative result at ≥2 wk of age)
6 wkStop ARV prophylaxisPCP prophylaxis is not needed if HIV-1 NAAT result is negative at 14 d and 4 wk of aged
8 wkNo HIV-1 NAAT needed if previous test results were negative at 14 d and 4 wk of ageA single negative result of HIV-1 NAAT performed at 8 wk of age allows presumptive exclusion of HIV-1 infectione
4 moHIV-1 NAATIf negative, HIV-1 infection is definitively excluded in the infant with previous presumptive exclusion
12–18 moEnzyme immunoassay for antibody to HIVTo confirm the absence of HIV infectionf
  • Scenario: infant born to an HIV-infected mother taking highly active ARV therapy since second trimester, virus load undetectable the week before delivery, and mother received 3 hours of ZDV intravenously before delivery.

  • a Either an HIV-1 DNA PCR or RNA assay.

  • b If any positive HIV-1 NAAT result, test is promptly repeated to confirm the diagnosis of HIV-1 infection (see “Management if an HIV-1 Virologic Test Result Is Positive”).

  • c Some experts recommend checking hemoglobin level or complete blood cell count at 2 weeks and/or 4 weeks of age. These more frequent measurements might be warranted for preterm infants or if the baseline hemoglobin level is low.

  • d If no testing was performed before this or only a single test was performed between 14 days and 6 weeks of age, start PCP prophylaxis at this point until HIV infection is presumptively excluded.

  • e If PCP prophylaxis was started because of indeterminate HIV-1 infection status from incomplete previous testing, it can be stopped when this 8-week test result is negative.

  • f Many experts confirm the absence of HIV-1 infection with a negative HIV-1 antibody assay result at 12 to 18 months of age.