Version July 2025
This algorithm reflects our UpToDate authors' recommendations for infant ART prophylaxis in resource-abundant settings. These recommendations are in accordance with the United States Department of Health and Human Services perinatal HIV guidelines. Guidance may vary in other countries; clinicians should refer to national guidelines when applicable. Guidance for infant ART prophylaxis in resource-limited settings is discussed elsewhere.
Prophylaxis should start as soon as possible after birth, preferably within 6 to 12 hours. Refer to other UpToDate content for dosing details. In addition to infant prophylaxis, lifelong ART is recommended for all mothers with HIV.
ART: antiretroviral therapy; ARV: antiretroviral viral; HIV: human immunodeficiency virus; RNA: ribonucleic acid.
* We recognize that not all pregnant, postpartum, and lactating individuals identify as women or mothers. The topics discussed here are based on risks driven by pregnancy and transmission of infection to the fetus/infant, and apply regardless of the pregnant person's gender identity. For simplicity, we use the term "mother" to signify the birthing biological parent of a child (regardless of gender identity and/or parental rights).
¶ Guidelines in many high-income countries recommend 2 or 4 weeks duration of zidovudine, but a small number support giving no prophylaxis to infants in low-risk scenarios. Refer to UpToDate topic on management of infants born to mothers with HIV in resource-abundant settings for further information.
Δ Shared decision making should take into consideration the risk of the infant acquiring HIV in utero (when birth mother had viremia), accessibility to reliable HIV testing for the infant after birth, and the concern for adverse ARV drug effects in the infant. Refer to the UpToDate topic on management of infants born to mothers with HIV in resource-abundant settings for further information.
◊ We suggest 2 weeks of the 3-drug regimen followed by 4 weeks of zidovudine alone if the HIV nucleic acid test from birth was negative. This approach minimizes potential adverse ARV drug effects for the infant. However, parents should be engaged in the decision making for determining duration of the 3-drug regimen when considering the balance between transmission risk and potential neonatal toxicities.
§ If infant was born to a mother with known or suspected resistance to nevirapine (or a mother who has HIV-2 infection), then raltegravir should be used instead of nevirapine (if possible based on the infant's age).
