5 Years Experience in 33 Preterms and Newborns at High Risk of Perinatal HIV-1 Transmission: HIV-1 Negative after a Triple Antiretroviral Prophylaxis

• Published in: Neuropediatrics
• Main Authors: Hien, S, Buchholz, B, Beichert, M, Schaible, T
• Format: Conference Proceeding
• Language: English
• Published: 13.11.2006
• ISSN: 0174-304X; 1439-1899
• DOI: 10.1055/s-2006-946530

Background: The low rate of vertical HIV-1 transmission of 1–2% in HIV-1 positive pregnant women has been achieved in Germany since 1995 by the combination of antiretroviral therapy for pregnant woman, caesarean section before onset of labor, refraining from breastfeeding and antiretroviral prophylaxis of the newborn. According to German-Austrian Guidelines in case of high risk of HIV-1 transmission for the newborn a triple antiretroviral prophylaxis is recommended. These guidelines are regularly updated by interdisciplinary consensus meetings, latest in 2005. Methods: In current update an Increase of HIV-1 Viral Load of the pregnant prepartally (IVL), Premature infants <33+0 weeks of GA (PRE), born after Amnionitis, Rupture of Membranes >4h (ROM), Incision Injury during Sectio (IIS), aspiration/ingestion of 2loody Amniotic Fluid (BAF) or no Pre- and/or intrapartal HIV-1 transmission Prophylaxis (NPP) are defined as a group of very high risk for vertical HIV-1 transmission. It is recommended to treat these newborn with Zidovudine, Lamivudine (both for 6 weeks) and with Nevirapine (once or twice). According to data from the HIVNET 012 study, a single dose of Nevirapine (200mg) given to the mother was combined with a single dose (2mg/kg Nevirapine) given to the newborn within 72 hours of birth. If Nevirapine was not administered to the mother prepartally the newborn received a first dose of 2mg/kg Nevirapine as soon as possible after birth up to 48 hours followed by a second dose within 72 hours. HIV-1 PCR was performed after 1,2,3 and 6 months to exclude or diagnose HIV-1 infection. Results: Since January 2000 altogether 33 newborn (2x IVL, 11x PRE, 4x ROM, 8x IIS, 3x BAF and 5x NPP), even 6 preterms less than 1000g birthweight, were treated with this high risk prophylaxis. Up to now 29 children were HIV-1 PCR negative after 1, 2, 3 and 6 months, 4 children have 3 negative HIV-1 PCR. Except of anaemia (9 cases, including preterms), one ASD and one VSD no adverse effects are registered. Conclusion: The triple antiretroviral therapy for HIV-1 exposed newborn with a very high risk of vertical HIV-1 transmission is very successful and well tolerated even by preterms with very low birth weight.