Newborn Testing and Prophylaxis Recommendations Following Low-Risk Perinatal HIV Exposure
Newborn Testing and Prophylaxis Recommendations Following Low-Risk Perinatal HIV Exposure HIV Infections
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Newborn Testing and Prophylaxis Recommendations Following Low-Risk Perinatal HIV Exposurea

Consult with Local/National ART Expert before Delivery.
Option: Perinatal HIV Hotline: (888) 448-8765

Known or suspected drug-resistant virus

End

Infant with Low-Risk Perinatal HIV Exposure

Infant HIV Testing


HIV Virologic Testing (RNA or DNA PCR) starting at 14–21 days of age
Complete Blood Count with Differential

Newborn Zidovudine (ZDV) Prophylaxis

Begin 2- to 6-week oral zidovudine monotherapyc as close to the time of birth as possible, dosed by gestational age at birth as below:


<30 weeks’ gestation: 2 mg/kg/dose BID
30 to <35 weeks’ gestation: Birth–2 weeks: 2 mg/kg/dose BID
2–4 weeks: 3 mg/kg/dose BID
>35 weeks’ gestation: 4 mg/kg/dose BID

Obtain HIV virologic testing (RNA or DNA PCR) of the infant at birth and proceed to Higher-Risk Perinatal HIV Exposure Algorithm (next page)

No ARV Prophylaxis Required

Presumptive HIV Therapy or ARV Prophylaxis; Proceed to Higher-Risk Perinatal
HIV Exposure Algorithm (next page)
+
Newborn HIV Testing


HIV Virologic Testing (RNA or DNA PCR) at birth
Complete Blood Count with Differential
+
Perform Supplemental HIV Testing in Birthing Parent
4th generation Ab/Ag testing, HIV-1/HIV-2 antibody differentiation immunoassay, and HIV Virologic Testing (RNA PCR or Viral Load)

Urgent parental and/or neonatal HIV test; HIV RNA test for birthing parent if acute HIV is suspected

a Low-risk criteria: (1) mother with HIV who received ART throughout pregnancy or from the early 1st/2nd trimester; AND (2) confirmed HIV RNA <50 copies/mL near delivery (within 4 weeks); AND (3) no concerns regarding ART adherence; AND (4) person did not have primary or acute HIV infection during pregnancy.

b Birthing people with previous negative HIV test at risk for seroconversion in late pregnancy are those with: documented STI, unprotected sex, partner with HIV, multiple partners, or IV drug use.

c If birthing parent has been on ART for at least 10 consecutive weeks during pregnancy and has maintained viral suppression (defined as at least 2 consecutive viral load measurements of <50 copies/mL at least 4 weeks apart), the infant can receive 2 weeks of ZDV. All other infants, and all infants <37 weeks’ gestational age, should receive 4-6 weeks of ZDV.

Meets Low-Risk Criteriaa