Maternal Intrapartum and Infant Prophylactic Antiretroviral Drug Regimens When an HIV-1—Infected Mother Has Not Received Prenatal Antiretroviral Therapy
Maternal Dosing, Intrapartum
Single 200-mg dose PO at onset of labor
2 mg/kg PO single dose
Single dose at 48–72 h
ZDV with 3TC
ZDV, 600 mg PO at onset of labor followed by 300 mg PO every 3 h until delivery; and 3TC, 150 mg PO at onset of labor followed by 150 mg PO every 12 h until delivery
ZDV, 4 mg/kg PO every 12 h; and 3TC, 2 mg/kg PO every 12 h
For 1 wk
2 mg/kg, IV bolus followed by continuous infusion of 1 mg/kg per h until delivery
2 mg/kg PO 4 times per day
Beginning 8–12 h after birth and continuing through 6 wk of age
If unable to tolerate oral therapy, 1.5 mg/kg IV every 6 h
If infant is preterm, 1.5 mg/kg every 12 hours for 2 weeks and then increase to 2 mg/kg every 8 h
ZDV with NVP
ZDV, 2 mg/kg IV bolus followed by continuous infusion of 1 mg/kg per h until delivery; and NVP, single 200-mg dose, PO, at onset of labor
ZDV, 2 mg/kg PO 4 times per day; and NVP, 2 mg/kg PO single dose
Start ZDV beginning 8–12 h after birth and continuing through 6 wk of age; and single dose of NVP at 48–72 h of age
IV indicates intravenous; PO, oral.
Care of the HIV-1-Exposed Infant (Birth to 6 Months of Age)
History and physical examination
Assess risk of other infections*
Antiretroviral prophylactic regimen†
CBC and differential leukocyte counts
HIV-1 DNA PCR or other virologic assays for HIV-1‡
Initiate prophylaxis for PCP§
If during this period the infant is diagnosed as HIV-1 infected, then laboratory monitoring and immunizations should follow the guidelines for treatment of pediatric HIV-1 infection.27 CBC indicates complete blood cell; arrows indicate the time intervals over which the procedure may be performed.
↵* Review maternal health information to assess for possible exposure to coinfections (see text).
↵† ZDV is usually the preferred prophylactic agent, although alternatives are: 1) ZDV with 3TC; 2) NVP; or 3) ZDV with NVP when the mother did not receive prenatal antiretroviral therapy (see Table 1). The arrow indicates treatment spanning from birth to 6 weeks of age.
↵‡ See text for discussion of HIV-1 virologic assays. If a test result is positive, repeat HIV-1 DNA PCR assay immediately to confirm infection. Some HIV-1 specialists suggest an additional HIV-1 DNA PCR test at 2 weeks of age. If clinical status or other laboratory parameters suggest HIV-1 infection, repeat testing as soon as possible. If by 4 months of age the test results are all negative for infection, testing for HIV-1 seroreversion at 12 to 18 months of age is indicated to definitively exclude HIV-1 infection.
↵§ The preferred prophylactic agent is trimethoprim-sulfamethoxazole; alternatives are dapsone, pentamidine, and atovaquone (Table 3). The arrow indicates the time interval over which the procedure may be performed.
Regimens for PCP Prophylaxis in Infants
Trimethoprim 150 mg/m2 per day, with sulfamethoxazole 750 mg/m2 per day
Twice daily for 3 days per wk (consecutive days, eg, Monday, Tuesday and Wednesday) or alternate days (every Monday, Wednesday, and Friday)
Alternatives: once daily for 3 days per wk or twice daily for 7 days per wk