HIV infection is a chronic illness with diverse clinical manifestations and psychosocial challenges. The routine care of HIV-infected children demands a dedicated multidisciplinary approach from a variety of health care professionals including medical sub-specialists, nurses, psychiatrists, psychologists, dentists, social workers and case managers. The HIV primary care provider, while ensuring health maintenance and preventing disease, must serve as the coordinator of an array of services crucial to the management of these children in the context of the family. Important management considerations attend the care of both HIV-exposed children and those children ultimately identified as HIV-infected.
Care of the HIV-exposed infant
Routine care for the infant born to an HIV-infected mother should begin well before the infant's birth. Clinicians should collaborate with the mother's primary care providers to minimize the risk of HIV transmission. Care of the infant after birth includes continued interventions to reduce the risk of HIV infection, as well as HIV diagnostic evaluations and routine infant care (Table 5.1). Care of the HIV-exposed newborn in the hospital begins with a thorough maternal history, including HIV disease status [HIV RNA concentration (viral load), CD4+ lymphocyte count, and HIV-related complications), receipt of interventions to prevent mother-to-child transmission (e.g., antiretroviral prophylaxis, cesarean delivery before labor and before ruptured membranes), and history of other infections (e.g., syphilis, herpes simplex virus, hepatitis B and C, cytomegalovirus, toxoplasmosis, gonorrhea, or tuberculosis (TB)).