CARE OF HIV EXPOSED INFANT

HIV-exposed infants should receive care at the mother-baby care point together with their mothers until they are 18 months of age. The goals of HIV-exposed infant care services are:

  • To prevent the infant from being HIV infected
  • Among those who get infected: to diagnose HIV infection early and treat
  • Offer child survival interventions to prevent early death from preventable childhood illnesses

The HIV Exposed Infant and the mother should consistently visit the health facility at least nine times during that period.

The visits are synchronised with the child’s immunisation schedule (i.e., at 6, 10 and 14 weeks, then at 5, 6, 9, 12, 15 and 18 months).

Management

Nevirapine prophylaxis

  • Provide NVP syrup from birth for 6 weeks
  • Give NVP for 12 weeks for babies at high risk, that is breastfeeding infants who mothers:
    • Have received ART for 4 weeks or less before delivery; or
    • Have VL >1000 copies in 4 weeks before delivery;
      or
    • Diagnosed with HIV during 3rd trimester or breastfeeding period (Postnatal)
  • Do PCR at 6 weeks (or at first encounter after this age) and start cotrimoxazole prophylaxis
    • If PCR positive, start treatment with ARVs and cotrimoxazole and repeat PCR (for confirmation)
    • If PCR negative and baby never breastfed, child is confirmed HIV negative. Stop cotrimoxazole, continue clinical monitoring and do HIV serology test at 18 months.
    • If PCR negative but baby has breastfed/is breasfeeding, start/continue cotrimoxazole prophylaxis and repeat PCR 6 weeks after
      stopping breastfeeding
  • Follow up any exposed child and do PCR if they develop any clinical symptom suggestive of HIV at any time and independently of previously
    negative results
  • For negative infants, do serology at 18 months before final discharge

Dosages of nevirapine

  • Child 0-6 weeks, 2-2.5 Kg: 10 mg once daily (1 ml of syrup 10 mg/ml)
  • Child 0-6 weeks, >2.5 kg: 15 mg once daily (1.5 ml of syrup 10 mg/ml)
  • Child 6 weeks – 12 weeks: 20 mg once daily (2 ml)

Cotrimoxazole prophylaxis

  • Provide cotrimoxazole prophylaxis to all HIVexposed infants from 6 weeks of age until they are proven to be uninfected. Dosages:
    • Child <5 kg: 120 mg once daily
    • Child 5-14.9 kg: 240 mg once daily
  • Infants who become HIV infected should continue to receive cotrimoxazole prophylaxis for life
  • If cotrimoxazole is contraindicated, offer dapsone at a dose of 2 mg/kg once daily ( up to 100 mg max)

Isoniazid (INH) preventive therapy (IPT)

  • Give INH for six months to HIV-exposed infant who are exposed to TB (close contact with PTB case) after excluding TB disease.
  • Dose: Isoniazid 10 mg/kg + pyridoxine 25 mg daily
  • For newborn infants, if the mother has TB disease and has been on anti-TB drugs for at least two weeks before delivery, INH prophylaxis is not
    required.

Immunisation

  • Immunise HIV exposed children as per national immunisation schedule
  • In case of missed BCG at birth, do not give if child has symptomatic HIV
  • Avoid yellow fever vaccine in symptomatic HIV
  • Measles vaccine can be given even in symptomatic HIV

Counselling on infant feeding choice

  • Explain the risks of HIV transmission by breastfeeding (15%) and other risks of not breastfeeding (malnutrition, diarrhoea)
  • Mixed feeding may also increase risk of HIV transmission and diarrhoea
  • Tell her about options for feeding, advantages, and risks
  • Help her to assess choices, decide on the best option, and then support her choice

Feeding options

  • Recommended option: Exclusive breastfeeding then complementary feeding after child is 6 months old
  • Exclusive breastfeeding stopping at 3-6 months old if replacement feeding possible after this
  • If replacement feeding introduced early, mother must stop breastfeeding
  • Replacement feeding with home-prepared formula or commercial formula and then family foods (provided this is acceptable, feasible, safe, and sustainable/ affordable)

If mother chooses breastfeeding

  • The risk may be reduced by keeping the breasts healthy (mastitis and cracked nipples raise HIV infection risk)
  • Advise exclusive breastfeeding for 3-6 months

If mother chooses replacement feeding

  • Counsel and teach her on safe preparation, hygiene, amounts, times to feed the baby etc.
  • Follow up within a week from birth and at any visit to health facility.