Acquired human immunodeficiency virus/ HIV in the neonatal period

Abstract

Blocking mother-to-child transmission was one of the greatest victories against HIV infection. A reduction in infection rates down to below 2% was achieved by applying strategies such as the recognition of maternal infection (HIV serological testing or rapid test) during the prenatal period or at delivery, use of antiretrovirals, elective route of delivery according to the patient’s viral load, and replacement of breastfeeding by formula. In Brazil, the recommended regimen includes the use of an anti-retroviral scheme composed of three anti-retroviral drugs from two different class es, from the 14th week of pregnancy (after the first trimester), in all pregnant women infected with HIV regardless of their virological or immunological parameters, use of intravenous zidovudine at the time of delivery, and of zidovudine in all children born to HIV infected mothers during the first four weeks of life. In special situations, adding other antiretrovirals, such as lamivudine and nevirapine, has been suggested. The benefits of maternal use of anti-retroviral drugs to prevent HIV transmission to children are unanimous. The safety of these short-term schemes has already been demonstrated, however, the association between maternal use of antiretrovirals drugs and congenital anomalies, prematurity, mitochondrial toxicity, anemia, neutropenia, and increased liver enzymes have been described. Serious effects rarely occur. Long-term follow-up of all children exposed to antiretroviral drugs is still necessary to answer many existing questions.