Nesheim et al developed a score for an infant born to an HIV-positive mother. This can help the clinician decide on whether to start antiretroviral therapy prior to receipt of NAT testing. The authors are from CDC.
Patient selection: neonate with HIV exposure at or near birth, with HIV-positive mother
Outcome: starting 3 antiretroviral drugs on day of birth
Parameters:
(1) sexually transmitted disease (STD) in mother
(2) substance abuse in mother
(3) mother's HIV viral load in copies per mL
(4) number of drugs in the mother's antiretroviral regimen
Parameter
Finding
Points
maternal STD
No
0
Yes
12
maternal substance abuse
No
0
Yes
18
HIV viral load
< 400
0
400-1,000
16
1,001-9,999
29
>= 10,000
43
number of antiretroviral drugs
0
27
1 or 2
7
>= 3
0
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 100
• The higher the score the greater the risk of HIV transmission to the neonate.
Performance:
• A score >= 7 had a sensitivity of 90% and specificity of 44%.
• A scorer >= 18 had a sensitivity of 86% and specificity of 57%.
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