An infant is evaluated at the office after developing prominent oral thrush, interstitial pneumonia, and severe lymphopenia during the first year of life. The patient was born full-term to a 25-year-old woman who received no prenatal care and has substance use disorder with intravenous drug use. She breastfed her son for the first month but then switched to formula feedings. The mother is currently unwilling to undergo any kind of testing. She tells the health care provider, "Just take care of my son." Which of the following prenatal interventions would have most likely prevented this infant's condition?

Question

An infant is evaluated at the office after developing prominent oral thrush, interstitial pneumonia, and severe lymphopenia during the first year of life.  The patient was born full-term to a 25-year-old woman who received no prenatal care and has substance use disorder with intravenous drug use.  She breastfed her son for the first month but then switched to formula feedings.  The mother is currently unwilling to undergo any kind of testing.  She tells the health care provider, "Just take care of my son."  Which of the following prenatal interventions would have most likely prevented this infant's condition?

Quizplus · Accepted Answer

Oral thrush, interstitial pneumonia, and severe lymphopenia during the first year of life are consistent with mother-to-child vertical transmission of HIV-1. The risk of HIV infection occurring in an infant born to an HIV-positive mother who received no prenatal antiretroviral therapy (ART) can be as high as 35%. ART during pregnancy reduces the risk of perinatal transmission to 1%-2%. All pregnant women with HIV should take ART, regardless of their CD4 cell count or viral load. Triple combination therapy is recommended for HIV-positive pregnant women (as it is for all HIV-positive adults) and most commonly has a backbone of 2 nucleoside/nucleotide reverse transcriptase inhibitors along with a third drug (protease inhibitor, non-nucleoside reverse transcriptase inhibitor, or integrase inhibitor). Drugs that are associated with a teratogenic risk (eg, efavirenz in first 8 weeks) or for which there is insufficient evidence during pregnancy are to be avoided. ART should be continued as long as women are breastfeeding. Infants generally receive several weeks of prophylaxis (zidovudine). (Choice B) Interferon-α is used for the treatment of hairy cell leukemia, condyloma acuminata, hepatitis B virus infection, and Kaposi sarcoma. (Choices C, D, F, and G) There are no vaccines currently available to prevent HIV. Infants whose mothers are HBsAg-positive should receive the hepatitis B vaccine and immunoglobulin within hours of birth to prevent perinatal transmission. There is no effective prevention for mother-to-child transmission of hepatitis C. (Choice E) Folic acid in prenatal vitamins (PNVs) can help prevent neural tube defects. Other important PNV components include iron (for hemoglobin synthesis), calcium (for bone growth), and iodine (for thyroid function). PNV intake does not prevent vertical transmission of HIV. Educational objective: Antiretroviral therapy during pregnancy reduces the risk of perinatal transmission of HIV to 1%-2% and is recommended for all pregnant women with HIV.

An Infant Is Evaluated at the Office After Developing Prominent