Infant HIV exposure, etc.

[NICU_Nurse, BSN, RN]

When a mom tests positive for HIV, are there laws in your state that cover mandatory notification of partners (not by nurses, I just mean in general)? Also, how long do you wait to start anti-retroviral therapy, etc. after the baby is born? Do you wait until you have consent from the mother or do you start automatically? Do you wait until the baby is a certain age, etc. What if you can't get in touch with the parents? How long do you go before you contact the courts to get an order? I was just thinking about some babies I heard about a while back- one was virtually abandoned by mom at birth and they didn't start treatment until three months later, when she finally called to find out how the baby was doing. Another was a mom who was apart from the father, who had a new girlfriend. Mom knew she was positive for over three years, but had had sex with dad as recently as eight months before, and he had no idea. I heard dad was coming in to see the baby nightly, and the nurses were strictly forbidden to discuss the HIV or medications with the father. He was bringing his girlfriend in, because they were going to be sharing custody of the baby with mom. Obviously, he was having sex with his new girlfriend as well, and SHE sure as hell didn't know about the mom's diagnosis. After hearing this, I was just thinking, what is the liklihood that this baby will get treatment or meds when it's at dad's house if he doesn't even know the baby is exposed/positive? Also heard about a mom who is a 'regular' who has eight children, four of them positive, and is about to have another pre-termer (thankfully not at our hospital, or my usual calm might escape me as I choke her!). Apparantly been positive for at least six years, hasn't told any of the fathers, one of whom is living with her now. So what gives in your state? It seems that *my* state needs some improvement.

[ShandyLynnRN, BSN, RN]

all I can say is YIKES!!!

[dawngloves, BSN, RN]

Yeah, me too!!!

We've only had one HIV+ baby I know of on the unit since I've been there and mom was very co operative.

[NicuGal, MSN, RN]

We get several a year. And that is a really sticky situation. Breach of confidentiality and all that. We can not mention it to the SO unless the mother says it is okay.

[KaroSnowQueen, RN]

I don't know about mother baby, but I do know I had an adult male patient who had been in the hospital about a month, very HIV positive, was into full blown AIDS, wife had NO IDEA!!! Absolutely none. He told her he respected her too much to sleep with her while he was "ill".......but not telling her "ill" with what. I think she thought he had cancer or emphysema or something.

Anyway, we discharged this man with AIDS and positive for TB to this woman's house and not one physician had told the wife what he had.

I thought this was disgusting!!!!!!!!!!!!!!!!!!!!!!!!!!!! WHERE did we get the idea that having a contagious, usually fatal illness fell into the category of privacy????? Perhaps the whole world doesn't need to know, but certainly the people living in close intimate contact with the infected person should be aware??????

[NICU_Nurse, BSN, RN]

Ahha! This is precisely what I was wondering about! Surely there must be some law ('s) in place, via Infectious Disease Dept. or what-not, to protect other partners or members of the family? I'm coming up with nothing. Everytime we discuss this at work, the only thing I hear is, 'Well, *I'm* not telling them...' Grrrrr. I'm not asking if *you* would want to tell them, I'm trying to find out what the LAW is. ;>) I KNOW that when I was in nursing school, we were taught that there are mandatory reporting laws of some kind in place to protect partners- they are notified anonymously that they may have been exposed in the last year and they should come in and get tested, etc. I'm just having a really hard time looking up more information about this. And NO ONE at work seems to know a bit about it. Thanks, guys. Let me know if you find anything else out. ;>)

[sunnygirl272]

Partner Notification

Partner notification for HIV infection or acquired immunodeficiency syndrome (AIDS), as for all STDs, is highly confidential and depends upon the voluntary cooperation of the patient. CDC currently recommends the following: "Persons who are HIV-antibody positive should be instructed in how to notify their partners and to refer them for counseling and testing. If they are unwilling to notify their partners or if it cannot be assured that their partners will seek counseling, physicians or health department personnel should use confidential procedures to assure that the partners are notified

[babynurselsa, RN]

Not sure about the legal notification part of it. Though I am wondering, is his name on teh birth certificate? If it is then he is at least allowed to be fully updated on teh baby's condition.

as far as anti-viral therapy of an infant of a known positive mom, AZT should be started within 6 hours of birth. Check Neo-Fax

[2banurse]

Kristi,

Since you brought this up, I have a question that maybe you or someone else on the board might now?...if a baby is HIV+ and they are treated right away, how likely is it that they can live as normal a life as possible? My heart goes out to those little babies who have absolutely no choice to live with this disease.

Thanks,

Kris

[NicuGal, MSN, RN]

If the mom was treated and the baby is treated right away, they almost never seroconvert. That is why it is important for these women to get good prenatal care!

[NICU_Nurse, BSN, RN]

The most recent statistic I read stated that if the infant is exposed to HIV and started on A-VT right away they have about a 65% chance of never seroconverting. The chances decrease even further if the mother had therapy while she was pregnant.