Northeast Florida Medicine
Vol. 66, No. 3 2015
55
CME
them into care early, even before they get pregnant. In
Jacksonville, this is done by offering HIV testing by several
state designated HIV testing sites, including UF CARES.
Innovative outreach programs are also conducted by UF
CARES, including programs such as Targeted Outreach
to Women with HIV/AIDS (TOPWA) and the Expanded
Testing Initiative (ETI). Both are funded by the Florida
Department of Health using CDC funds. Once identified,
HIV-infected women receive intensive case management
and referral to obstetric providers.These women are followed
by UF CARES case managers along with their obstetric
providers. Women have access to mental health services
at UF CARES, along with many other essential services.
Women are also offered access to the latest innovative
research at UF CARES through research projects funded
by the National Institutes of Health and the CDC. All
women have access to the latest intervention protocols
to interrupt MTCT. Once the infants are born they are
followed by the pediatric HIV providers from UF CARES
and receive the necessary interventions. These infants also
have access to cutting edge research.
Treatment of Infants
Infants born toHIV-infectedmothers need antiretroviral
therapy for at least six weeks. It is imperative the mother
leaves the hospital with the necessary prescriptions. Fol-
low-up at appropriate intervals is necessary so that diagnosis
of HIV infection can be detected as soon as possible. Early
treatment with antiretrovirals and prophylaxis for PCP
infection in the infant is critical to decrease the morbidity
and mortality associated with MTCT of HIV infection.
Other opportunistic infections, such as tuberculosis, are
fortunately rare in children in the United States, but are
still a huge problem in the under resourced parts of the
world. Nevertheless, HIV-infected children are at increased
risk for tuberculosis and require appropriate screening for
tuberculosis on a regular basis. Early diagnosis of HIV in-
fection in the newborn period and the first 18-24 months
of age requires molecular tests, such as HIV DNA or RNA
PCR and, in some cases, a NAAT test. The routinely-used
antibody-based HIV testing for adults is not accurate in
infants, because of the presence of transplacentally acquired
maternal HIV antibody.
Treatment of Children
Although many antiretroviral treatment options are
available for children, the management of HIV-infected
children is highly specialized. Such children should be
managed by pediatric infectious diseases specialists who
are experienced and knowledgeable about the latest treat-
ment guidelines for pediatric HIV infection. Management
of HIV is quite fluid and dynamic as the field burgeons
and evolves. The latest information can be obtained from
living documents at AIDSinfo.org.
All healthcare providers have a critical role in the preven-
tion of MTCT of HIV. First and foremost, all healthcare
providers and institutions should offer HIV testing to their
patients annually, as recommended by the CDC in 2006.
8
This will identify HIV-infected individuals so that they
can receive appropriate treatment. Such treatment would
decrease the chance of MTCT if a woman gets pregnant.
Testing of HIV-infected men would identify potentially
infected women. When appropriately treated and educat-
ed, HIV-infected men would be less likely to transmit the
infection to their uninfected partners. As a result, a female
partner would be less likely to transmit to their infants.
Treatment of Adolescents
and Emerging Adults
Adolescent HIV cases, although not strictly defined by
the CDC as pediatric HIV, are usually cared for by pediat-
ric HIV specialists. This is a hard to reach group and even
harder to retain in care. This is also the group of individuals
in the pediatric HIV domain who are increasing in number.
While the traditionally defined pediatric HIV infection
cases are usually the result of MTCT, adolescents are usually
behaviorally infected. At UF CARES special programs for
adolescents (13-18 years old) and emerging adults (19-24
years old), focus on their specific needs phased on their
maturity and psychosocial development. Perhaps the most
challenging group in this age group are those with alternate
life styles, including the lesbian, gay, bisexual, transgender and
questioning (LGBTQ) communities who are at heightened
risk for many life problems, including HIV. Young men
who have sex with men are particularly at risk for HIV and
especially vulnerable and difficult to reach.
Florida statistics show that in 2014, 16 percent of all new
HIV infections occurred in individuals less 25 years of age.
9
Between 2012 and 2014, 548 new cases of HIV infection
were reported among those between 13 to 19 years of age
and 2,117 cases among those between 20 and 24 years
of age.
9
As of June 30, 2014 a total of 3,768 adolescents
between the ages of 13 and 24 years old were infected.
9
While there has been tremendous success in preventing
MTCT of HIV infection, there is a long way to go to
identify and provide services to young people infected
with HIV or at risk for HIV.
