Counselling of parents on the care of infants born to HIV positive mothers is an essential component of the management of HIV infected children. Management strategies include:
HIV diagnostic testing for both the mother and child
Scheduled clinic visits for care
Chemoprophylaxis with Trimethoprim/Sulfamethoxazole, (Cotrimoxazole is TMP-SMX) even if HIV status is unconfirmed
Mothers should be counselled on the disadvantages and advantages of breastfeeding, paying particular attention to the risk of breastfeeding for short or long duration, and mixed feeding and advantages of exclusive breast-feeding. (Please refer to the ‘Infant Feeding Guidelines in HIV/AIDS’ provided by the Ministry of health). Care of the mother after delivery and during follow up including treatment of opportunistic infections should also be emphasized. Mothers should receive psychosocial support through counselling in the postnatal period.
Infants of HIV infected mothers should receive prophylactic treatment against PCP and other opportunistic infections using TMP-SMX from 6 weeks of age. This should be given orally as per dosing table 6.2 until the HIV status of the infant is known. The care of HIV infected children is detailed in Chapter 12. TMP-SMX may need to continue after breastfeeding with on-going exposure to HIV.