Last reviewed: May 2020
Last updated: December  2019

Summary

Definition

History and exam

Key diagnostic factors

  • increased risk of maternal HIV infection
  • increased risk of perinatal HIV transmission

Other diagnostic factors

  • oral candidiasis
  • increasing dyspnoea
  • weight loss
  • fever
  • malaise
  • lymphadenopathy
  • maculopapular blanching rash

Risk factors

  • needle-sharing with injection drug use
  • receptive penile-vaginal intercourse
  • unprotected receptive anal intercourse
  • percutaneous needle prick
  • sexually transmitted infections (STIs) and bacterial vaginosis
  • high maternal viral load (perinatal transmission)
  • absence of antenatal maternal antiretroviral therapy (perinatal transmission)
  • breastfeeding (perinatal transmission)
  • violence against women and girls
  • receptive oral intercourse
  • insertive oral intercourse
  • multiple sexual partners
  • low maternal CD4 count (perinatal transmission)

Diagnostic investigations

1st investigations to order

  • maternal HIV-1/HIV-2 antigen/antibody enzyme-linked immunosorbent assay (ELISA)
  • maternal HIV-1/HIV-2 antibody differentiation immunoassay
  • neonatal HIV DNA or RNA polymerase chain reaction (PCR)
More 1st investigations to order

Investigations to consider

  • HIV-1 western blot
  • HIV-1 indirect immunofluorescence assay (IFA)
  • HIV-1 nucleic acid test (NAT)
  • CD4 count
  • plasma viral load
  • renal function tests
  • liver function tests (LFTs)
  • tests for co-infections
  • drug resistance test (genotyping)
  • full blood count
  • glucose screening
  • fetal ultrasound
More investigations to consider

Treatment algorithm

Contributors

Assistant Professor of Obstetrics and Gynecology

Georgetown University School of Medicine

Scientific Director of Women’s Health Research

MedStar Health Research Institute

Director

MedStar WHC Women's Center for Positive Living

MedStar Washington Hospital Center Department of Women’s and Infants’ Services

Washington

DC

Disclosures

RKS declares that she is a principal investigator on a Gilead Investigator Sponsored Research Award through MedStar Health Research Institute.

Dr Rachel K. Scott would like to gratefully acknowledge Dr Isaac Delke, Dr Christina Bailey, and Dr Mettassebia Kano, the previous contributors to this topic.

Peer reviewersVIEW ALL

Assistant Professor of Medicine

Associate Residency Program Director

University of Chicago

Chicago

IL

Disclosures

AS declares that she has no competing interests.

Reader in Communicable Diseases

Faculty of Medicine

Imperial College

London

UK

Disclosures

GPT has been reimbursed by various pharmaceutical companies for attending conferences, lecturing, and consulting, and has been chief investigator of investigator-initiated industry-funded research on HIV and pregnancy.

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