Krist Alex H, Crawford-Faucher Amy
Fairfax Family Practice Residency, Virginia Commonwealth University School of Medicine, 22033, USA.
Am Fam Physician. 2002 May 15;65(10):2049-56.
The management of infants whose mothers are infected with the human immunodeficiency virus (HIV) involves minimizing the risk of vertical transmission of HIV, recognizing neonatal HIV infection early, preventing opportunistic infections, and addressing psychosocial issues. Maternal antiretroviral drug therapy during pregnancy and labor, followed by six weeks of neonatal zidovudine therapy, can significantly decrease the risk of vertical transmission. Additional antiretroviral drugs may be needed in some high-risk newborns. Elective cesarean section also may prevent vertical transmission of HIV. Virologic tests allow early diagnosis of HIV infection, facilitating the timely initiation of aggressive treatment and the prevention of opportunistic infections. Even when tests are negative, infants must be closely monitored until age 18 months to completely rule out HIV infection. Prophylaxis for Pneumocystis carinii pneumonia should be initiated when HIV-exposed infants are six weeks old and should be continued for at least four months, regardless of negative virologic tests, because P. carinii pneumonia is often the initial presentation of HIV infection in infants. Laboratory monitoring, screening for perinatal infections, appropriate social support, and other modifications of standard infant care are also necessary.
对母亲感染人类免疫缺陷病毒（HIV）的婴儿进行管理，包括尽量降低HIV垂直传播的风险、尽早识别新生儿HIV感染、预防机会性感染以及解决心理社会问题。孕期和分娩期间进行母亲抗逆转录病毒药物治疗，随后进行六周的新生儿齐多夫定治疗，可显著降低垂直传播的风险。一些高危新生儿可能需要额外的抗逆转录病毒药物。选择性剖宫产也可能预防HIV的垂直传播。病毒学检测可早期诊断HIV感染，有助于及时开始积极治疗并预防机会性感染。即使检测结果为阴性，也必须对婴儿进行密切监测，直至18个月大，以完全排除HIV感染。对于暴露于HIV的婴儿，应在六周大时开始预防性治疗卡氏肺孢子虫肺炎，且无论病毒学检测结果如何，均应持续至少四个月，因为卡氏肺孢子虫肺炎通常是婴儿HIV感染的最初表现。实验室监测、围产期感染筛查、适当的社会支持以及对标准婴儿护理的其他调整也很有必要。
