What is included in ART prophylaxis for infants exposed to HIV?

Updated: Apr 02, 2019
  • Author: Ashley T Peterson, MD; Chief Editor: Ronald M Ramus, MD  more...
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Answer

Answer

All HIV-exposed infants should receive zidovudine in the following doses for the first six weeks of life:

  • < 30 weeks’ gestation: 2 mg/kg PO BID; after age 4 weeks, advance to 3 mg/kg PO BID

  • >30 to < 35 weeks’ gestation: 2 mg/kg PO BID; after age 2 weeks, advance to 3 mg/kg PO BID

  • >35 weeks’ gestation: 4 mg/kg PO BID

Initiate as soon after delivery as possible (preferably within 6-12 hours) and continue through age 6 weeks and administer birth through 6 weeks. For infants unable to tolerate IV doses, the IV dose is 75% of the oral dose while maintaining the same dosing interval. A simplified weight-band dosing for infants ≥ 35 weeks is also published and available via the NIH guidelines.

Additional prophylaxis with nevirapine is needed for HIV-exposed infants of women who did not receive antepartum ART at the following weights and dosages:

  • Birth weight 1.5-2 kg: 8 mg/dose PO

  • Birth weight >2 kg: 12 mg/dose PO

Administer 3 doses in the first week of life; 1st dose 48 hours after birth, give 2nd dose 48 hours after 1st dose, and 3rd dose 96 hours after 2nd dose.

Three-drug infant combined ART prophylaxis regimens are under investigation, however some experts are already using these in clinical practice (please refer to current guidelines available via the NIH).


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