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Antiretroviral Dosing for Neonates With Perinatal HIV Exposure

Medication (Oral)*

Low-Risk Prophylaxis (4 Weeks Total Treatment)

High-Risk Therapy (6 Weeks Total Treatment)‡

≥ 35 weeks gestation at birth: ZDV 4 mg/kg twice daily

≥ 35 weeks gestation at birth: ZDV 4 mg/kg twice daily

≥ 30 to < 35 weeks gestation at birth:

  • Birth to age 2 weeks: ZDV 2 mg/kg twice daily

  • Age 2−4 weeks: ZDV 3 mg/kg twice daily

≥ 30 to < 35 weeks gestation at birth:

  • Birth to age 2 weeks: ZDV 2 mg/kg twice daily

  • Age 2–6 weeks: ZDV 3 mg/kg twice daily

< 30 weeks gestation at birth:

  • ZDV 2 mg/kg twice daily

< 30 weeks gestation at birth:

  • Birth to age 4 weeks: ZDV 2 mg/kg twice daily for 4 weeks

  • Age 4–6 weeks: ZDV 3 mg/kg twice daily

Not applicable

≥ 32 weeks gestation at birth:

  • Birth to age 4 weeks: 3TC 2 mg/kg twice daily

  • Age 4–6 weeks: 3TC 4 mg/kg twice daily

Not applicable

≥ 37 weeks gestation at birth:

  • NVP 6 mg/kg twice daily

34 to < 37 weeks gestation at birth:

  • Birth to age 1 week: NVP 4 mg/kg twice daily

  • Age 1–6 weeks: NVP 6 mg/kg twice daily

32 to 34 weeks gestation at birth:

  • Birth to age 2 weeks: NVP 2 mg/kg twice daily

  • Age 2–4 weeks: NVP 4 mg/kg twice daily

  • Age 4–6 weeks: NVP 6 mg/kg twice daily 

Not applicable

≥ 37 weeks gestation at birth and weighing ≥ 2 kg:

  • Birth to age 1 week: About 1.5 mg/kg once a day

  • Age 1–4 weeks: About 3 mg/kg twice daily

  • Age 4–6 weeks: About 6 mg/kg twice daily

* ARV medications should begin as soon as possible, preferably within 6 to 12 hours of delivery. See table Neonatal Antiretroviral Management According to Risk of HIV Infection for details regarding risk of perinatal transmission. Consulting an expert in pediatric HIV is recommended when selecting a therapy duration based on case-specific risk factors and interim HIV test results. For ARV management after the neonatal period, see the Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection from the Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV.

† For neonates who cannot tolerate oral medications, ZDV can be given IV at 75% of the oral dose, using the same dosing interval.

‡ Further increases in ZDV and NVP doses are used for infants proved to have HIV infection and for infants receiving longer prophylaxis because of HIV exposure via breastfeeding, depending on their gestational and chronologic ages; an expert in pediatric HIV medicine should be consulted.

ART = antiretroviral therapy; ARV = antiretroviral.

Adapted from the Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV: Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. Accessed 02/08/2023.

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