August Week 3: Congenital HIV

Simpkins E, et al. Thinking about HIV Infection. Peds in Review. 2009;30;337-349.
Burchett S, et al. HIV Infection in Infants, Children, and Adolescents. Peds in Review. 2003;24;186

Case 1:
You are on call in the NICU and are called to the C section delivery of an HIV+ woman who had no prenatal care. She went into preterm labor at 34 wks and had a fever of 39C in L&D. The infant is delivered and brought to the NICU for sepsis workup.

When do you test the infant for HIV? 
What tests do you order? 
What do you recommend about feeding?

Case 2:
A 16 yo male comes to your office for a school physical. During your HEEADSSS assessment, he tells you he has had sex with both males and female and did not use condoms every time. Unfortunately, his OraQuick is positive.

What is your next step? 
If his confirmatory test is positive, what else should you send if you haven’t already? What if the patient was female?
When should he start antiretroviral treatment? 
When and how should he begin prophylaxis against OIs?

Case 3: 
A 20 yo male presents to your office for a college physical. He denies drug use, says he always uses condoms, and has never had a blood transfusion. What routine labs would you order during this physical?

Case 4:
A 12 month old patient with congenital HIV comes to clinic for a well visit. She is also follwed by Dr Morel in ID clinic. Her last CD4 count 1 month ago was 212. What vaccines, if any, do you order?

Case 5
You are on call in the PICU placing a central line in a patient who was found unconscious after a drug overdose and is now in hypovolemic shock. You recap the needle you were using to inject lidocaine and stick yourself when you twist off the cap.

What do you do next? 
What are chances of transmission of HIV, HCV, and HBV?