Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States
The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.
Management of Infants Born to Women with HIV Infection
Antiretroviral Management of Newborns with Perinatal HIV Exposure or Perinatal HIV
Last Updated: December 7, 2018; Last Reviewed: December 7, 2018
|Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials with clinical outcomes and/or validated laboratory endpoints; II = One or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = Expert opinion
Table 8. Newborn Antiretroviral Management According to Risk of HIV Infection in the Newborn
Drug selection and dosing considerations are related to the age and gestational age of the newborn. Consultation is available through the National Perinatal HIV Hotline (888-448-8765).
|Category||Description||Neonatal ARV Management|
|Low Risk of Perinatal HIV Transmission||
||ZDV for 4 weeks|
|Higher Risk of Perinatal HIV Transmissiona,b||
||2-drug ARV prophylaxis (NICHD-HPTN 040/PACTG 1043 regimen) with 6 weeks ZDV and 3 doses of NVP (prophylactic dosage, with doses given within 48 hours of birth, 48 hours after first dose, and 96 hours after second dose)
Empiric HIV therapy using either ZDV, 3TC, and NVP (treatment dosage) or ZDV, 3TC, and RAL administered from birth to age 6 weeks.d
|Presumed Newborn HIV Exposure||
||ARV management as above (for higher risk of perinatal HIV transmission).
Infant ARVs should be discontinued immediately if supplemental testing confirms that the mother does not have HIV.
|Newborn with HIVe||
||3-drug ARV regimen using treatment dosages|
|a See text for evidence supporting a 2-drug ARV prophylaxis regimen and empiric HIV therapy.
b See the Intrapartum Care section for guidance on indications for scheduled cesarean delivery and intrapartum IV ZDV to reduce the risk of perinatal HIV transmission for mothers with an elevated viral load at delivery.
c Most Panel members would opt to administer empiric HIV therapy to infants whose mothers had acute HIV during pregnancy because of the higher risk for in utero transmission. If acute HIV is diagnosed during breastfeeding, mother should stop breastfeeding.
d The optimal duration of empiric HIV therapy in newborns at higher risk of perinatal HIV transmission is unknown. Some Panel members opt to discontinue NVP, RAL, and/or 3TC when a birth NAT returns negative, while others would continue empiric HIV therapy for infants at highest risk of HIV acquisition for 6 weeks. In all cases, ZDV should be continued for 6 weeks. It is recommended that providers consult with an expert in pediatric HIV infection to determine therapy duration based on case-specific risk factors and interim HIV NAT results.
e Most Panel members do not recommend delaying the initiation of ART pending results of the confirmatory HIV NAT, given low likelihood of a false-positive HIV NAT.
Note: ARV drugs should be initiated as close to the time of birth as possible, preferably within 6 to 12 hours of delivery. See Table 9 for dosing specifics.
Key to Acronyms: 3TC = lamivudine; ART = antiretroviral therapy; ARV =antiretroviral; IV = intravenous; NAT = nucleic acid test; NVP = nevirapine; the Panel = Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission; RAL = raltegravir; ZDV = zidovudine
- AIDSinfo Drug Database
- AIDSinfo Patient Materials: Preventing Mother-to-Child Transmission of HIV
- AIDSinfo Patient Materials: HIV Medicines During Pregnancy and Childbirth
- AIDSinfo Patient Materials: Protecting Baby from HIV
- AETC National HIV Curriculum
- How to Cite These Guidelines
- Perinatal Guidelines Archive