Neonatal Antiretroviral Management According to Risk of HIV Infection
Perinatal HIV Transmission Risk | Maternal/Neonatal Factors | Neonatal HIV Management* |
|---|---|---|
Low | Mother received ART during pregnancy. Mother had sustained virologic suppression (as shown by HIV plasma viral load of < 50 copies/mL) near delivery. There were no concerns about mother's adherence to ART. | ARV prophylaxis: ZDV for 4 weeks† |
High | Mother did not receive ART during pregnancy. Mother did not receive antepartum or intrapartum ARV medications. Mother received only intrapartum ARV medications. Mother received antepartum and intrapartum ARV medications but had an unknown or a detectable (≥ 50 copies/mL) HIV plasma viral load near delivery (particularly when delivery was vaginal). Mother had acute or primary HIV infection during pregnancy or breastfeeding in which case breastfeeding should be stopped immediately. Mother had unconfirmed HIV status with ≥ 1 positive HIV test at delivery or postpartum.‡ | Three-drug presumptive HIV therapy:or |
* ARV medications should begin as soon as possible, preferably within 6 to 12 hours of delivery. See table Antiretroviral Dosing for Neonates With Perinatal HIV Exposure for dosing specifics. | ||
† Some experts advise ZDV may be given for 2 weeks to select infants born at ≥ 37 weeks gestation to women who meet low-risk criteria, who have been given ART for more than 10 consecutive weeks, and who have maintained viral suppression for the duration of the pregnancy (see the Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV's Management of Infants Born to People with HIV Infection). | ||
‡ Stop neonatal treatment if later testing confirms mother does not have HIV infection. | ||
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. | ||