A term infant is born to a known HIV-positive mother. She has been taking antiretroviral medications for the weeks prior to the delivery of her infant. Routine management of the healthy infant should include which of the following?
## **Core Concept**
The management of infants born to HIV-positive mothers involves preventing postnatal transmission of HIV to the infant. This is achieved through antiretroviral prophylaxis. The infant's exposure to HIV from the mother during pregnancy, labor, and breastfeeding necessitates immediate postnatal intervention to reduce the risk of HIV acquisition.
## **Why the Correct Answer is Right**
The correct approach for the routine management of a healthy infant born to an HIV-positive mother who has been on antiretroviral therapy is to administer antiretroviral prophylaxis to the infant. This typically involves a single dose of **nevirapine** to the mother during labor and a dose to the infant within 72 hours of birth. However, guidelines evolve, and current recommendations may favor **zidovudine (AZT)** monotherapy for the infant, started as soon as possible after birth for 4-6 weeks. This approach significantly reduces the risk of mother-to-child transmission of HIV.
## **Why Each Wrong Option is Incorrect**
- **Option A:** While certain antiretroviral drugs are used for prophylaxis, without specifying the drug or regimen, it's hard to assess its correctness directly. However, if it suggests no intervention, that would be incorrect.
- **Option B:** This option might suggest an incorrect regimen or timing for antiretroviral prophylaxis, which could be less effective or not recommended based on current guidelines.
- **Option C:** Similarly, this could propose an alternative that is not aligned with standard recommendations for post-exposure prophylaxis in this context.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **zidovudine (AZT)** is a cornerstone in the prevention of mother-to-child transmission of HIV. For infants, a 4-6 week course of AZT is often recommended. Additionally, HIV testing for infants born to HIV-positive mothers should be performed, with the first test at 14-21 days of age and another at 9 months of age.
## **Correct Answer:** D. Administer zidovudine (AZT) to the infant for 4-6 weeks.