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.

  •   Table of Contents

Download Guidelines

Management of Infants Born to Women with HIV Infection

Initial Postnatal Management of the Neonate Exposed to HIV

Last Updated: December 7, 2018; Last Reviewed: December 7, 2018

Panel's Recommendations for Initial Postnatal Management of the Neonate Exposed to HIV
Panel's Recommendations
  • A complete blood count and differential should be performed on newborns as a baseline evaluation (BIII).
  • If hematologic abnormalities are identified in infants receiving prophylaxis, decisions on whether to continue infant antiretroviral (ARV) prophylaxis need to be individualized. Consultation with an expert in pediatric HIV infection is advised if early discontinuation of prophylaxis is considered (CIII).
  • Decisions about the timing of subsequent monitoring of hematologic parameters in infants depend on the infant’s baseline hematologic values, gestational age at birth, clinical condition, infant receipt of zidovudine, other ARV drugs, and concomitant medications; and maternal antepartum therapy (CIII).
  • Hemoglobin and neutrophil counts should be remeasured 4 weeks after initiation of prophylaxis for infants who receive combination zidovudine/lamivudine-containing ARV prophylaxis regimens (AI).
  • Routine measurement of serum lactate is not recommended. However, measurement of the enzyme can be considered if an infant develops severe clinical symptoms of unknown etiology (particularly neurologic symptoms) (CIII).
  • Virologic tests are required to diagnose HIV infection in infants aged <18 months (see Diagnosis of HIV Infection in Infants and Children) (AII).
  • To prevent Pneumocystis jirovecii pneumonia (PCP), all infants born to women with HIV should begin PCP prophylaxis at ages 4 to 6 weeks, after completing their ARV prophylaxis regimen, unless there is adequate test information to presumptively exclude HIV infection (see the Pediatric Opportunistic Infections Guidelines) (AII).
  • Health care providers should routinely inquire about breastfeeding and premastication and advise caregivers on safe feeding options (AII).
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

Download Guidelines