3-Drug Presumptive HIV Therapy for 6 Weeks^c
Zidovudine

Gestational Age <35 wks at birth:

Birth to 2 weeks of age: 2 mg/kg po BID^b
>2 weeks of age: 3 mg/kg po BID^b

Gestational Age >35 weeks at birth: 4 mg/kg po BID^b,^d
PLUS
Lamivudine (3TC)^c

Birth to 4 wks of age: 2 mg/kg/dose po BID
>4 wks of age: 4 mg/kg/dose po BID
PLUS EITHER
Nevirapine

Gestational Age >37 weeks

6 mg/kg/dose po BIDd

Gestational Age 34–<37 weeks

Birth to 1 week of age: 4 mg/kg dose po BID
>1 week of age: 6 mg/kg/dose po BID^d

Gestational Age 32–<34 weeks

Birth to 2 weeks of age: NVP 2 mg/kg per dose po BID
2 to 4 weeks of age: NVP 4 mg/kg per dose po BID

4 to 6 weeks of age: NVP 6 mg/kg per dose po BID
OR
Raltegravir^e
Gestational Age ≥37 weeks
Birth to 1 week of age: 1.5 mg/kg/dose po QD
1 week to 4 weeks of age: 3 mg/kg/dose po BID
4 weeks to 6 weeks of age: 6 mg/kg/dose po BID

Zidovudine
Prophylaxis

Only Zidovudine dosing established
Can start Zidovudine 2 mg/kg po BIDb
For combination therapy advice, consult with local/national experts
Option: HIV Perinatal Hotline, (888) 448-8765

End

^a Higher-risk criteria: birthing parents (1) who received neither antepartum nor intrapartum ARVs; OR (2) who received only intrapartum ARVS; OR (3) who received ante- and intrapartum ARVs but who do not have viral suppression (HIV RNA <50 copies/mL) near delivery, particularly if delivery was vaginal; OR (4) with acute or primary HIV infection during pregnancy or breastfeeding, in which case the person should discontinue breastfeeding.

^b For newborns who are unable to tolerate oral agents, the IV dose of zidovudine is 75% of the oral dose, while maintaining the same dosing interval.

^c All infants at higher risk of perinatal HIV exposure should be tested by HIV RNA or DNA PCR at birth. If birth HIV virologic testing in newborn is negative, some experts would discontinue lamivudine and nevirapine after 2 weeks and complete 6 weeks of prophylaxis with zidovudine alone.

^d ARV doses (such as ZDV and nevirapine) may need to be changed and the ARV regimen may need to be optimized if the infant has confirmed HIV infection. See clinicalinfo.hiv.gov for full dosing guidelines for infants with confirmed HIV infection.

^e If the birthing person has taken raltegravir 2–24 hours prior to delivery, the neonate's first dose of raltegravir should be delayed until 24–48 hours after birth; additional ARV drugs should be started as soon as possible. Do not use raltegravir if gestational age <37 weeks.