The last and first frontier : emerging challenges for HIV treatment and prevention in the first week of life with emphasis on premature and low birth weight infants
Date
2015-12-02
Journal Title
Journal ISSN
Volume Title
Publisher
International AIDS Society
Abstract
Abstract
Introduction: There is new emphasis on identifying and treating HIV in the first days of life and also an appreciation that low
birth weight (LBW) and preterm delivery (PTD) frequently accompany HIV-related pregnancy. Even in the absence of HIV, PTD
and LBW contribute substantially to neonatal and infant mortality. HIV-exposed and -infected infants with these characteristics
have received little attention thus far. As HIV programs expand to meet the 90-90-90 target for ending the HIV pandemic,
attention should focus on newborn infants, including those delivered preterm or of LBW.
Discussion: In high prevalence settings, infant diagnosis of HIV is usually undertaken after the neonatal period. However, as
in utero infection may be diagnosed at birth, earlier initiation of therapy may limit viral replication and prevent early damage.
Globally, there is growing awareness that preterm and LBW infants constitute a substantial proportion of births each year.
Preterm infants are at high risk for vertical transmission. Feeding difficulties, apnoea of prematurity and vulnerability to sepsis
occur commonly. Feeding intolerance, a frequent occurrence, may compromise oral administration of medications. Although
there is growing experience with post-exposure prophylaxis for HIV-exposed term newborn infants, there is less experience with
preterm and LBW infants. For treatment, there are even fewer options for preterm infants. Only zidovudine has adequate dosing
recommendations for treating term and preterm infants and has an intravenous formulation, essential if feeding intolerance
occurs. Nevirapine dosing for prevention, but not treatment, is well established for both term and preterm infants.
HIV diagnosis at birth is likely to be extremely stressful for new parents, more so if caring for preterm or LBW infants. Programs
need to adapt to support the medical and emotional needs of young infants and their parents, where interventions may be
lifesaving.
Conclusions: New focus is required for the newborn baby, including those born preterm, with LBW or small for gestational age
to consolidate gains already made in early diagnosis and treatment of young children.
Description
CITATION: Cotton, M. F. et al. 2015. The last and first frontier : emerging challenges for HIV treatment and prevention in the first week of life with emphasis on premature and low birth weight infants. Journal of the International AIDS Society, 18(Suppl 6):20271, doi:10.7448/IAS.18.7.20271.
The original publication is available at http://www.jiasociety.org
The original publication is available at http://www.jiasociety.org
Keywords
HIV infections -- Prevention, Birth weight, Low, Antiretroviral therapy, Highly active, HIV infections -- Diagnosis, 90-90-90 target, Prematurely born children -- Diseases, AZT (Drug)
Citation
Cotton, M. F. et al. 2015. The last and first frontier : emerging challenges for HIV treatment and prevention in the first week of life with emphasis on premature and low birth weight infants. Journal of the International AIDS Society, 18(Suppl 6):20271, doi:10.7448/IAS.18.7.20271.