HIV-infected Pregnant Woman Research Articles

ТЕЧЕНИЕ БЕРЕМЕННОСТИ У ВИЧ-ИНФИЦИРОВАННЫХ ЖЕНЩИН

The article presents the peculiarities of pregnancy in HIV-infected women. Prevention of HIV transmission from the pregnant woman to the fetus can reduce the level of perinatal infection by more than 8%. An important aspect in preventing fetal infection is the timely registration of an HIV-infected pregnant woman in a women's clinic, the rejection of invasive prenatal diagnosis, the choice of the optimal antiviral treatment regimen and method of delivery, the prohibition of breastfeeding. The tactics of managing pregnant women with HIV infection is an urgent problem of obstetrics.

Condom Use in Male Partners and Associated Factors Among HIV-positive Women Who Accessed PMTCT Services During Pregnancy in Jos, Nigeria

Despite being on antiretroviral therapy, during unprotected sex, a HIV-infected pregnant woman can transmit HIV not only to a HIV-negative sexual partner but also pose a risk for reinfection with new or resistant viral strains between her and a HIV-positive sexual partner, and ultimately to her baby. Condom use is a recognized strategy to reduce this risk if practiced consistently. This study set out to determine condom use and associated factors among a cohort of women who attended PMTCT clinic in Jos University Teaching hospital. Methods: Ninety-six enrolled women provided information about themselves and their male partners via a questionnaire, and other relevant information was obtained from their hospital records. Data obtained was analyzed using Epi info version 7 (CDC Atlanta, GA). The mean age of the women was 36.4±4.5 years. They were predominantly married (90.6%), Christians (75.0%), and educated above primary school level (88.6%). The mean age of the male partners was 45.3±6.1 years and over half of them (57.3%) were HIV-positive. The prevalence of consistent condom use in the participants was low (26.0%). Only 4.2% of male partners had ever received counselling in the PMTCT clinic. Factors significantly associated with condom use were younger age of male partner (mean ± SD=43.0±4.7 years), younger age of pregnant women (mean ± SD=34.2±3.3 years), Christian faith of the women, male partners having ever accompanied their pregnant woman for counselling in the PMTCT clinic and viral load of < 1000 copies/ml (P value=0.0290, 0.0035, 0.0440, 0.0227 and 0.0045 respectively). The practice of consistent condom use among male partners of HIV-positive pregnant women attending PMTCT clinic in JUTH was low, suggesting the need for improved strategies to optimize its usage. Involvement of male partners in PMTCT counselling is significantly associated with consistent condom use and should therefore be advocated to augment efforts towards fighting sexual and perinatal HIV transmission.

Temporal trend and risk factors for mother-to-child HIV transmission in Southern Brazil, 2007-2017

Abstract Background HIV infection affects women of childbearing age, and unplanned pregnancies among those infected are prevalent. This fact increases the potential risk for mother-to-child transmission during pregnancy, childbirth or postpartum through breastfeeding. The Brazilian Ministry of Health recommends anti-HIV testing for all pregnant women. Access to antiretroviral therapy is available through prenatal and maternity care, and breastfeeding is contraindicated. The detection rate of pregnant women living with HIV in Brazil has increased by 23.8% in the last ten years. The aim of this study was to estimate the incidence of seroconversion of HIV infection in children exposed to mother-to-child transmission and examine associated risk factors for the period 2007-2017 in Santa Catarina, Brazil. Methods A historical cohort study was conducted using secondary data related to the notifications of HIV-infected pregnant woman and follow-up of HIV-exposed infants. Odds ratios were used to estimate the risk of infection. Results We identified 5,554 HIV-infected pregnant women and 4,559 HIV-exposed infants, 130 of whom had confirmed seroconversion, which corresponds to a rate of 2.9%. Antiretroviral use during pregnancy [OR = 9.31 (5.97-14.52) p &amp;lt; 0.001] and breastfeeding [OR = 3.10 (1.34-7.20) p = 0.008] were found to be independent risk factors for seroconversion. Between 2007 and 2017, there was a 78.3% increase in the number of HIV-infected pregnant women, but the seroconversion rate among infants reduced by 20.4%. Conclusions The study concluded that, between 2007 and 2017, the HIV seroconversion rate was 2.9% among live births, with a tendency to decrease. Seroconversion was associated with not using antiretroviral therapy during pregnancy and breastfeeding. These data reveal gaps in prenatal care regarding adherence to treatment and follow-up of HIV-infected mothers, resulting in new HIV infections among children that could otherwise be prevented. Key messages Vertical transmission of HIV is a public health challenge, which requires strategies for surveillance and quality care. This study may provide relevant information to promote public health policies, with quality care for pregnant women and children living with HIV/AIDS.

Assessment of awareness and knowledge regarding HIV/AIDS among first year MBBS students in a Medical College in Maharashtra India

AIDS is a complex of illnesses caused by HIV. AIDS is the most advanced stage of HIV infection. According to recent reports by NACO, as many as 21.40 lac people are living with HIV (PLHIV) in India. Prevention of new HIV infections continues to be the mainstay of India’s national AIDS response. The lack of awareness and misconceptions about HIV/AIDS in the general population is mostly responsible for rapid spread of the disease and also with the social stigma attached with PLHIV in our country. Hence the present study was conducted to assess awareness regarding HIV/AIDS in newly admitted (First Year) medical students. This was a cross-sectional study done on 122 First Year MBBS students of Shri Bhausaheb Hire Govt. Medical College, Maharashtra. Data was collected by pretested questionnaires and analyzed using percentage. All students (100%) mentioned unsafe sex and infected blood transfusion as a risk behavior. Most of the respondents believed HIV infection can be transmitted from: HIV infected pregnant woman to her baby (93%), breast feeding (62%), contaminated syringes, needles and razors (98%), tattooing (64%) and IV drug abuse (66%). Students were aware that it does not spread through wearing clothes of HIV-infected persons (92%), mosquito bite (77%), hugging and shaking hands with an infected person (97%), sharing common toilets (81%), sharing common utensils like plates, cups and spoons (84%), saliva (81%), contact with urine (48%) and feces (51%), coughing and sneezing (75%) and sharing a meal (93%). Awareness regarding prevention of HIV/AIDS was also found to be high with percentage of students responding for oral contraceptive pills (84%), IUCD (61%), condoms(98%), health education(99%), avoiding untested blood transfusion(100% boys and 95% girls), use of disposable syringe (85%), avoiding breastfeeding (44%) and use of latex gloves (41%). 82% of respondents are willing to assist with the delivery of a baby born to a mother with HIV/AIDS. All students believed that a separate educational programme for awareness and sensitization towards HIV/AIDS for people engaged in healthcare is needed. The present study shows that the medical students have somewhat better awareness and knowledge regarding HIV/AIDS than the general population. Still, there is a need for specific educational modules for imparting positive attitudes in medical students and healthcare providers in relation to people living with HIV/AIDS.

The reproductive health and sexual behavior of HIV-infected women: the review

The increased access to effective anti-retroviral treatment (ART) has made HIV comparable to chronic disease in terms of life expectancy. The advances in scientific knowledge and, in particular, in management of HIV-infected pregnant woman have reduced the risk of mother-to-child transmission of HIV. The analysis of current research demonstrates that HIV has been a problem in terms of sexuality and reproduction. The needs related to sexuality and reproduction are crucial ones to overall health and well-being of HIV-infected population. The future research is to focus not only on how sexual relations and relationships of HIV-positive women are manifested, but also on how health care system is to provide adequate support to women in relation with sexuality and reproduction. The purpose of study was to apply analysis of current research on sexuality, sexual and contraceptive behavior and implementation of reproductive function in HIV-infected women and the conditions affecting this realization. The review of national and international scientific publications concerning such areas as gynecology, reproductive health, sexuality and reproductive behavior of HIV-positive women from indexed on-line journals and relevant websites using such search engines as PubMed and Google in 1997-2019. The sample included 34 peer-reviewed qualitative studies, which covered 9523 HIV-positive surveyed women. The technique of interpretative meta-synthesis was applied to generalize and evaluate how experiences of HIV-positive women in sexuality and reproduction behavior have been described in qualitative studies. The effective anti-retroviral treatment has made HIV comparable to chronic disease in terms of life expectancy. The analysis of current research on this topic established that HIV was a problem in terms of sexuality and reproduction. The conditions that make the burden of HIV more severe are: HIV is an obstacle for starting and continuing relationship, providing sense of fear and loss. At the same time motherhood, spiritual beliefs, and supportive relationships made the burden of HIV easier. The HIV-positive test in women makes their sexual and reproductive health more complicated because of HIV status. Therefore, women face such unique challenges as problems in partnerships, sexual satisfaction and childbearing. The study results are important for developing optimal medical care to alleviate the burden of HIV infection. In addition to medical care, health care workers should consider social and psychological needs to support HIV-positive patients in improving their health and their sexual and reproductive health as well.

REPRODUCTIVE DISORDERS AND THEIR PATHOGENETIC MECHANISMS IN WOMEN WITH HIV

Background . Highly active antiretroviral therapy (ART) has increased the life expectancy of people living with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Advances in scientific knowledge and, in particular, in the management of an HIV-infected pregnant woman have also reduced the risk of mother-to-child transmission of HIV. Aims . Consider the current problems of gynecological and reproductive health disorders and the pathophysiological aspects of these disorders in HIV-infected women. Methods . Review of Russian and international scientific publications related to gynecology, reproductive health and HIV infection from indexed online journals and relevant websites using Pubmed and Google search from 1990 to March 2019. Results. In recent years, the proportion of HIV-infected women has increased and the role of sexual transmission of infection has increased, as well as the active involvement of women of reproductive age in the HIV epidemic. In HIV-infected pregnant women who did not receive HAART, the frequency of obstetric complications, labor and adverse outcomes in children is increased. HIV infection can reduce the fertility of women at any stage of the disease, marked violations of the menstrual cycle and ovulation, reduced ovarian reserve and the quality of oocytes. In HIV-infected patients, weight loss and dystrophy, impaired thyroid function, adrenal glands and hypogonadism are recorded. Violations of the menstrual, ovulatory function can occur for a variety of reasons that are not directly related to their illness, but to multiple stressors. HIV-positive women suffer from increased frequency and severity of pelvic infections and precancerous and malignant lesions of the cervix. Conclusions. Gynecological, reproductive needs, as well as the specifics of monitoring an HIV-positive woman are not sufficiently assessed, are not optimal and are largely ignored, which can negatively affect their quality of life and efforts to combat the HIV epidemic.

Determination of raltegravir and raltegravir glucuronide in human plasma and urine by LC–MS/MS with application in a maternal-fetal pharmacokinetic study

Raltegravir (RAL) is a HIV-integrase inhibitor recommended for treatment of HIV type 1 infection during pregnancy. The elimination of RAL to RAL glucuronide (RAL GLU) is mediated primarily by UDP glucuronosyltransferase 1A1 (UGT1A1). The present study shows the development and validation of 4 different methods for the analysis of RAL and RAL GLU in plasma and in urine samples. The methods were applied to evaluate the maternal-fetal pharmacokinetics of RAL and RAL GLU in a HIV-infected pregnant woman receiving RAL 400 mg twice daily. The sample preparation for RAL and RAL GLU analysis in 25 μL plasma and 100 μL diluted urine (10-fold with water containing 0.1% formic acid) were carried out by protein precipitation procedure. RAL and RAL GLU generate similar product mass fragments and require separation in the chromatographic system, so a suitable resolution was achieved for unchanged RAL and RAL GLU employing Ascentis Express C18 (75 × 4.6 mm, 2.7 μm) for both plasma and urine samples. The methods showed linearities at the ranges of 0.1–13.5 μg/mL RAL and 0.15–19.5 μg/mL RAL GLU in urine and 10–2000 ng/mL RAL and 2.5–800 RAL GLU in plasma. Precise and accurate evaluation showed coefficients of variation and relative errors ≤ 15%. The methods have been successfully applied in a maternal-fetal pharmacokinetic study.

Социальный портрет ВИЧ-инфицированной беременной женщины

Социальный портрет ВИЧ-инфицированной беременной женщины

The Impact of Couple HIV Testing and Counseling on Consistent Condom Use Among Pregnant Women and Their Male Partners: An Observational Study.

In sub-Saharan Africa couple HIV testing and counseling (CHTC) has been associated with substantial increases in safe sex, especially when at least one partner is HIV infected. However, this relationship has not been characterized in an Option B+ context. The study was conducted at the antenatal clinic at Bwaila District Hospital in Lilongwe, Malawi in 2016 under an Option B+ program. Ninety heterosexual couples with an HIV-infected pregnant woman (female-positive couples) and 47 couples with an HIV-uninfected pregnant woman (female-negative couples) were enrolled in an observational study. Each couple member was assessed immediately before and 1 month after CHTC for safe sex (abstinence or consistent condom use in the last month). Generalized estimating equations were used to model change in safe sex before and after CHTC and to compare safe sex between female-positive and female-negative couples. Mean age was 26 years among women and 32 years among men. Before CHTC, safe sex was comparable among female-positive couples (8%) and female-negative couples (2%) [risk ratio (RR): 3.7, 95% confidence interval (CI): 0.5 to 29.8]. One month after CHTC, safe sex was higher among female-positive couples (75%) than among female-negative couples (3%) (RR: 30.0, 95% CI: 4.3 to 207.7). Safe sex increased substantially after CTHC for female-positive couples (RR 9.6, 95% CI: 4.6 to 20.0), but not for female-negative couples (RR: 1.2, 95% CI: 0.1 to 18.7). Engaging pregnant couples in CHTC can have prevention benefits for couples with an HIV-infected pregnant woman, but additional prevention approaches may be needed for couples with an HIV-uninfected pregnant woman.

Mother and child both matter: reconceptualizing the prevention of mother-to-child transmission care continuum.

To propose a prevention of mother-to-child transmission (PMTCT) care continuum that defines the programmatic steps necessary to provide HIV care to the HIV-infected pregnant woman and her infant during the risk period for HIV transmission. There are several complexities of PMTCT care that should be considered in the care continuum, including the evolution in the population of women entering PMTCT care, various models of PMTCT service delivery and patterns of PMTCT care, and the critical step of transfer of women's HIV care from PMTCT programs to adult HIV clinics. We propose a reconceptualized PMTCT care continuum that accounts for the complexities of PMTCT care. We also propose a combined outcome for pregnant women and their infants across an interlinked PMTCT continuum to measure both maternal and child health outcomes.

Correlation between Asymptomatic Bacteriuria and HIV-1 Viral Load Level and CD4 Count in Pregnant Women on Antiretroviral Therapy in N’djamena (Chad)

A cross-sectional study was conducted at the “Centre de l’Appui Psycho-Médico-Social (APMS)” which is a centre for Psychological and Medical Support in N'Djamena (Chad) from January to March 2014. The aim of this study was to evaluate the correlation between asymptomatic bacteriuria (ASB) and viral load level and CD4 count in seventy-six (76) HIV-1 infected pregnant women on antiretroviral therapy (ART). Urine culture and bacteria identification were performed by using a chromogenic culture medium (UriselectR4). T CD4+ lymphocytes count and viral load measurement were done respectively on PIMATM test and Abbott m2000 RealTime HIV-1. In this study, 25 (32.9%) pregnant women were carrying ASB and major bacteria; Escherichia coli and Streptococcus agalactiae known to cause neonatal meningitis to newborns were identified. Bacteria were isolated mainly in women with CD4 lymphocytes 3log (70%) (19/25). Besides the prevention of mother to child transmission of HIV, which remains a goal, it is important to prevent also the transmission of other microorganisms causing neonatal infections. Our findings support the needs to do bacteriological analysis of urine in every HIV-infected pregnant woman at least in late pregnancy.

Maternal multivitamin supplementation reduces the risk of diarrhoea among HIV-exposed children through age 5 years.

The aim of this study was to determine whether maternal vitamin supplementation affects long-term mortality and morbidity of children born to HIV-infected mothers. In total, 1078 HIV-infected pregnant woman were enrolled in a double-blind, 2×2 factorial, randomised, placebo-controlled trial in Tanzania. Data were collected for 874 children at monthly clinic visits through a median age of 51 months. Maternal receipt of multivitamins (HR=0.93; 95% CI: 0.70-1.22) or vitamin A (HR=1.00; 95% CI: 0.76-1.32) did not affect all-cause child mortality through age 5 years. Among HIV-negative children, maternal multivitamin supplementation was associated with a lower mortality rate up to 5 years (HR=0.60; 95% CI: 0.38-0.95), primarily in children <2 years of age. Maternal vitamin A supplementation did not significantly affect child mortality up to 5 years (HR=0.76; 95% CI: 0.48-1.20). Children born to mothers who received multivitamins had a lower risk of all types of diarrhoea (RR=0.86; 95% CI: 0.75-0.98) through 5 years of age. The reduced risk of watery diarrhoea persisted in children from 2-5 years of age (RR=0.71; 95% CI: 0.54-0.95). Maternal vitamin supplementation during pregnancy and lactation may be associated with long-lasting affects in HIV-exposed children [ClinicalTrials.gov Identifier: NCT00197743].

Care of the HIV-infected pregnant woman in the developed world.

The reduction of human immunodeficiency virus (HIV) transmission from mother to child is one of the success stories of modern medicine and public health. In the developed world, with universal HIV counseling and testing, antiretroviral prophylaxis, scheduled Caesarean delivery if indicated, and avoidance of breastfeeding, HIV transmission from mother to infant can be <2%. Despite this, transmissions continue to occur, often due to lack of knowledge of HIV status. Missed opportunities for prevention and prevention challenges include late prenatal care, lack of HIV testing in pregnancy, lack of preconception counseling, unintended pregnancy, and substance abuse. We review preconception counseling including options for serodiscordant couples, and antepartum, peripartum and postpartum care of the HIV-infected woman in the developed world, and advocate for a comprehensive, collaborative, multidisciplinary approach.

Using vignettes in qualitative research to explore barriers and facilitating factors to the uptake of prevention of mother-to-child transmission services in rural Tanzania: a critical analysis

BackgroundVignettes are short stories about a hypothetical person, traditionally used within research (quantitative or qualitative) on sensitive topics in the developed world. Studies using vignettes in the developing world are emerging, but with no critical examination of their usefulness in such settings. We describe the development and application of vignettes to a qualitative investigation of barriers to uptake of prevention of mother-to-child transmission (PMTCT) HIV services in rural Tanzania in 2012, and critique the successes and challenges of using the technique in this setting.MethodsParticipatory Learning and Action (PLA) group activities (3 male; 3 female groups from Kisesa, north-west Tanzania) were used to develop a vignette representing realistic experiences of an HIV-infected pregnant woman in the community. The vignette was discussed during in-depth interviews with 16 HIV-positive women, 3 partners/relatives, and 5 HIV-negative women who had given birth recently. A critical analysis was applied to assess the development, implementation and usefulness of the vignette.ResultsThe majority of in-depth interviewees understood the concept of the vignette and felt the story was realistic, although the story or questions needed repeating in some cases. In-depth interviewers generally applied the vignette as intended, though occasionally were unsure whether to steer the conversation back to the vignette character when participants segued into personal experiences. Interviewees were occasionally confused by questions and responded with what the character should do rather than would do; also confusing fieldworkers and presenting difficulties for researchers in interpretation. Use of the vignette achieved the main objectives, putting most participants at ease and generating data on barriers to PMTCT service uptake. Participants’ responses to the vignette often reflected their own experience (revealed later in the interviews).ConclusionsParticipatory group research is an effective method for developing vignettes. A vignette was incorporated into qualitative interview discussion guides and used successfully in rural Africa to draw out barriers to PMTCT service use; vignettes may also be valuable in HIV, health service use and drug adherence research in this setting. Application of this technique can prove challenging for fieldworkers, so thorough training should be provided prior to its use.

Amniocentesis in HIV Pregnant Women: 16 Years of Experience

The iatrogenic risk of HIV vertical transmission, calculated in initial epidemiologic studies, seemed to counterindicate invasive prenatal diagnosis (PND) procedures. The implementation of highly active antiretroviral therapy (HAART) represented a turning point in PND management, owing to a rapid and effective reduction of maternal viral load (VL). In the present study, we identified cases of vertical transmission in HIV-infected pregnant women who did amniocentesis in the second trimester of pregnancy (n = 27), from 1996 to 2011. We divided our sample into Group A—women under HAART when submitted to amniocentesis (n = 20) and Group B—women without antiretroviral therapy before amniocentesis (n = 7). We had 1 case of vertical transmission in Group B. Preconceptional or early first trimester HIV serology is essential to avoid performing an amniocentesis without antiretroviral therapy or viral suppression. When there is an indication for amniocentesis in an HIV-infected pregnant woman, it should be done if the patient is on HAART and, if possible, when VL is undetectable. Nowadays, with combined first trimester screening test to select pregnancies with high risk of aneuploidies, advanced maternal age is a less frequent indication to perform PND invasive procedures, representing an outstanding gain in prenatal diagnosis of this population.

Guideline on invasive obstetric procedures in the HIV-infected pregnant woman

Antenatal invasive obstetric procedures in HIV-infected pregnant women are associated with a risk of mother-to-child HIV transmission. There are limited published data on the subject. The general consensus is that any HIV-infected pregnant woman who needs to undergo an invasive procedure should have combination antiretroviral therapy initiated prior to the procedure, regardless of the CD4+ cell count. The recommendations in this guideline, developed to assist clinicians in counselling and managing HIV-infected pregnant women in need of an invasive procedure, are based on small observational studies and local experience.

A workshop report on promoting HIV/AIDS understanding through a capacity building train-the-trainer educational intervention

Nursing educators are frequently confronted with challenges that bring about innovation and transition to new ways of transferring knowledge in their home environments. These challenges are magnified when approached from an international perspective. Optimal implementation of knowledge transfer incorporates choosing models that promote local initiatives in line with increasingly decentralized educational structures. These decentralized models are a means to foster ongoing participation for both educators and students in their own professional development. Innovative education stems from creativity in approaching the need with formats and activities to meet a specific challenge. This experimental study builds upon previous study by the authors which was conducted in March, 2009, based upon the qualitative open focus forum at each of the five nursing programs. Overwhelmingly, the Cameroonian nursing students expressed a keen desire to study the HIV infected pregnant woman and the feeding options of the newborn. The study team developed the train-the-trainer program which was delivered at the University of Buea in the Southwest region of Cameroon in March, 2011. TTT is particularly effective for reaching large audiences and also permits a degree of sustainability such that the Cameroonian students will be trainers for subsequent cohorts of their peers. This study continues to strengthen the collaborative endeavors between the two nursing schools; the University of Buea (UB) and Goldfarb School of Nursing (GSON) at Barnes Jewish College in Saint Louis, Missouri, USA. The final aim of the intervention was the initiation of collaborative relationships between the faculty members of the two educational organizations.

Vertical transmission of HIV and toxoplasma by reactivation in a chronically infected woman

Prevention of mother-to-child transmission of HIV and Toxoplasma dual infections in the immunocompromised patient remains a healthcare challenge. We report a case of congenital toxoplasmosis resulting from reactivation of latent infection in a severely immunodepressed HIV-infected pregnant woman, who had poor adherence to therapy; this case illustrates the difficulties encountered in management of such a rare condition.

AIDS in Pregnancy, Part II: Treatment in the Era of Highly Active Antiretroviral Therapy and Management of Obstetric, Anesthetic, and Pediatric Issues

International guidelines recommend resistance testing of maternal virus for all human immunodeficiency virus (HIV)-infected pregnant women. The use of highly active antiretroviral therapy leads to maximal virologic suppression, thus minimizing the risk of drug resistance, but it is available only in developed countries. In developing countries, the use of short-course regimens is becoming more widespread. Women infected with HIV may be at greater risk for complications during pregnancy, including ectopic pregnancy, early abortions, bacterial pneumonia, urinary tract infection, oral and recurrent vaginal thrush, malaria, and tuberculosis. Regional anesthesia is often the treatment of choice when administering anesthesia in an HIV-infected pregnant woman. Infected children present decreased survival rates, while uninfected children born to infected mothers present a higher incidence of poor weight gain, short stature, and wasting than would be expected for the general population. Transmission of HIV-1 can occur via breast-feeding.

Neonatal HIV infection.

The purpose of this article is to describe the pertinent issues related to mother-to-child transmission of HIV infection. Significant succcss has been achieved in developed countries to reduce the incidence of this devastating disease in neonates through screening of pregnant women, maternal antiretroviral therapy to reduce transmission, and cesarean section for delivery. Prophylaxis continues for the first six weeks of the newborn's life with antiretroviral therapy and careful monitoring of clinical well-being. Antiretroviral therapy offers significant reduction in the rate of mother-to child transmission, and this is presently the cornerstone of therapy for the HIV-infected pregnant woman. Clinical studies of treatment modalities continue to offer new hope to prevent transmission of the virus to the fetus. Care for the HIV infected newborn is highly complex and constantly evolving. All neonatal nurses should be aware of these issues so that they can be partners in the identification of new cases and the ongoing treatment of babies who are infected.