The last and first frontier : emerging challenges for HIV treatment and prevention in the first week of life with emphasis on premature and low birth weight infants

dc.contributor.authorCotton, Mark F.en_ZA
dc.contributor.authorHolgate, Sandien_ZA
dc.contributor.authorNelson, Aurelieen_ZA
dc.contributor.authorRabie, Helenaen_ZA
dc.contributor.authorWedderburn, Catherineen_ZA
dc.contributor.authorMirochnick, Marken_ZA
dc.date.accessioned2016-10-18T05:51:37Z
dc.date.available2016-10-18T05:51:37Z
dc.date.issued2015-12-02
dc.descriptionCITATION: Cotton, M. F. et al. 2015. The last and first frontier : emerging challenges for HIV treatment and prevention in the first week of life with emphasis on premature and low birth weight infants. Journal of the International AIDS Society, 18(Suppl 6):20271, doi:10.7448/IAS.18.7.20271.
dc.descriptionThe original publication is available at http://www.jiasociety.org
dc.description.abstractAbstract Introduction: There is new emphasis on identifying and treating HIV in the first days of life and also an appreciation that low birth weight (LBW) and preterm delivery (PTD) frequently accompany HIV-related pregnancy. Even in the absence of HIV, PTD and LBW contribute substantially to neonatal and infant mortality. HIV-exposed and -infected infants with these characteristics have received little attention thus far. As HIV programs expand to meet the 90-90-90 target for ending the HIV pandemic, attention should focus on newborn infants, including those delivered preterm or of LBW. Discussion: In high prevalence settings, infant diagnosis of HIV is usually undertaken after the neonatal period. However, as in utero infection may be diagnosed at birth, earlier initiation of therapy may limit viral replication and prevent early damage. Globally, there is growing awareness that preterm and LBW infants constitute a substantial proportion of births each year. Preterm infants are at high risk for vertical transmission. Feeding difficulties, apnoea of prematurity and vulnerability to sepsis occur commonly. Feeding intolerance, a frequent occurrence, may compromise oral administration of medications. Although there is growing experience with post-exposure prophylaxis for HIV-exposed term newborn infants, there is less experience with preterm and LBW infants. For treatment, there are even fewer options for preterm infants. Only zidovudine has adequate dosing recommendations for treating term and preterm infants and has an intravenous formulation, essential if feeding intolerance occurs. Nevirapine dosing for prevention, but not treatment, is well established for both term and preterm infants. HIV diagnosis at birth is likely to be extremely stressful for new parents, more so if caring for preterm or LBW infants. Programs need to adapt to support the medical and emotional needs of young infants and their parents, where interventions may be lifesaving. Conclusions: New focus is required for the newborn baby, including those born preterm, with LBW or small for gestational age to consolidate gains already made in early diagnosis and treatment of young children.en_ZA
dc.description.urihttp://www.jiasociety.org/index.php/jias/article/view/20271?search=frontier
dc.description.versionPublisher's version
dc.format.extent5 pages
dc.identifier.citationCotton, M. F. et al. 2015. The last and first frontier : emerging challenges for HIV treatment and prevention in the first week of life with emphasis on premature and low birth weight infants. Journal of the International AIDS Society, 18(Suppl 6):20271, doi:10.7448/IAS.18.7.20271.
dc.identifier.issn1758-2652
dc.identifier.otherdoi:10.7448/IAS.18.7.20271
dc.identifier.urihttp://hdl.handle.net/10019.1/99725
dc.language.isoen_ZAen_ZA
dc.publisherInternational AIDS Society
dc.rights.holderAuthors retain copyright
dc.subjectHIV infections -- Preventionen_ZA
dc.subjectBirth weight, Lowen_ZA
dc.subjectAntiretroviral therapy, Highly activeen_ZA
dc.subjectHIV infections -- Diagnosisen_ZA
dc.subject90-90-90 targeten_ZA
dc.subjectPrematurely born children -- Diseasesen_ZA
dc.subjectAZT (Drug)en_ZA
dc.titleThe last and first frontier : emerging challenges for HIV treatment and prevention in the first week of life with emphasis on premature and low birth weight infantsen_ZA
dc.typeArticleen_ZA
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