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Dosing for antiretroviral drugs for extended prophylaxis in breastfeeding infants*

Dosing for antiretroviral drugs for extended prophylaxis in breastfeeding infants*
Drug Available formulation Gestational age at birth Dosing
Lamivudine (3TC) Oral solution (10 mg/mL) For all gestational ages, administer 3TC after completion of initial prophylaxis with ZDV
  • Age 2 weeks to <4 weeks:
    • 2 mg/kg/dose orally twice daily
  • Age ≥4 weeks to 12 months:
    • Use simplified weight-band dosing outlined in the table below:
Weight band (kg) Dose (volume) of 3TC 10 mg/mL oral solution
2 to <3 kg 10 mg (1 mL) orally twice daily
3 kg to <4 kg 15 mg (1.5 mL) orally twice daily
4 kg to <8 kg 25 mg (2.5 mL) orally twice daily
≥8 kg 50 mg (5 mL) orally twice daily
Nevirapine (NVP)Δ Oral suspension (10 mg/mL) ≥32 weeks
  • Birth to age 6 weeks:
    • 2 to 3 kg: NVP 10 mg (1 mL) orally once daily
    • ≥3 kg: NVP 15 mg (1.5 mL) orally once daily
  • Age 6 weeks to 6 months:
    • NVP 20 mg (2 mL) orally once daily
  • Age 6 to 9 months:
    • NVP 30 mg (3 mL) orally once daily
  • Age 9 to 18 months:
    • NVP 40 mg (4 mL) orally once daily
This table provides general dosing information for antiretroviral agents for extended prophylactic use in breastfed infants after completion of initial prophylactic regimen. The table should be used in conjunction with UpToDate content on management of infants born to mothers with HIV in resource-abundant settings. Continuation of ARV prophylaxis in breastfed infants is based on assessment of current and anticipated virologic status of the breastfeeding parent.

3TC: lamivudine; ARV: antiretroviral; IV: intravenous; NVP: nevirapine; ZDV: zidovudine.

* Continued antiretroviral prophylaxis for breastfeeding infants is generally initiated after initial prophylaxis is complete and when there are concerns about maternal adherence to antiretroviral therapy. Refer to the UpToDate text on management of infants born to mothers with HIV in resource-abundant settings for further details.

¶ These doses are only for prophylaxis regimens in breastfed infants without confirmed HIV infection. If the infant is diagnosed with HIV infection or the breastfeeding parent develops viremia during breastfeeding, initiate a 3-drug HIV therapy regimen. Refer to United States Department of Health and Human Services Guidelines for the Use of Antiretroviral Agents in Pediatric HIV infection for further information.

Δ If there is known/suspected NVP-resistant virus in the breastfeeding parent or if the infant cannot tolerate NVP, 3TC should be used instead for extended ARV prophylaxis during breastfeeding.

Adapted from: Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States. https://clinicalinfo.hiv.gov/en/guidelines/perinatal/management-infants-utero-intrapartum-breastfeeding-hiv-exposure (Accessed on January 2, 2025).
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