Management

This is a complex subject; however principles can be summarised as:

• interruption of transmission. There is evidence that AZT given to an HIV positive mother from the 16th week of gestation until delivery, and then to six weeks old in the baby can reduce transmission by up to 60%. There is also evidence to suggest that elective caesarian section may be protective to the infant.
• prevention of superinfection - here immunisation has an important role to play, with septrin given regularly to try to prevent pneumocystis
• social and psychological care

Treatment options are the same as in adults - there is an increasing use of combination antiretroviral therapy (ART) and also prophylaxis against Pneumocystic carinii pneumonia (PCP). These management changes have been reflected in a major improvement in the prognosis of children with HIV infection, especially in the first year of life (1).

Treatment of HIV-infected pregnant women is described in the menu option below.

Reference:

1. The European Collaborative Study. Fluctuations in symptoms in human immunodeficiency virus-infected children; the first 10 years of life.Pediatrics 2001;108:116-22