Version July 2025
| Risk of vertical transmission | Prophylactic regimen |
| All infants born to mothers with HIV | |
| Born to a mother who had HIV RNA levels <50 copies/mL from 20 weeks of gestation through delivery | Zidovudine administered for 2 weeks. |
| Born to a mother who had HIV RNA levels ≥50 copies/mL after 20 weeks of gestation, but had HIV RNA levels <50 copies/mL within 4 weeks of delivery | The decision to provide prophylaxis with zidovudine alone versus presumptive therapy with a 3-drug regimen should be made by shared decision making between clinicians and parents, taking into account the degree and duration of maternal viremia, timing of viremia during pregnancy, and the risk of adverse drug effects in the infant. |
| Born to a mother who had HIV RNA levels ≥50 copies/mL within 4 weeks of delivery | Three-drug regimen (zidovudine, lamivudine, and either nevirapine or raltegravir*) for 2 to 6 weeks¶. If 3-drug regimen is stopped earlier than 6 weeks, then zidovudine alone should be continued for the remainder of the 6 weeks. |
| Continuation of infant prophylaxis in breastfed infants | |
| Born to a mother with sustained viral suppression on ART | Initial ARV prophylaxis (as determined above). The decision to provide infant prophylaxis after the initial ARV prophylaxis given to all infants should be made by shared decision making between providers and parents, taking into account anticipated concerns about maternal viremia and individual risk tolerance. Extended prophylaxis options include:
|
| Born to a mother without sustained viral suppression on ART | Breastfeeding is not recommended◊. |
ART: antiretroviral therapy; ARV: antiretroviral; HIV: human immunodeficiency virus; NAAT: nucleic acid amplification test; RNA: ribonucleic acid.
* Raltegravir (instead of nevirapine) should be used in infants born to mothers with suspected or known resistance to nevirapine or who are infected with HIV-2.
¶ The optimal duration of presumptive HIV therapy in newborns at high risk of vertical HIV transmission is unknown. We suggest a 3-drug regimen for 2 weeks followed by 4 weeks of zidovudine alone, if the HIV NAAT at birth was negative. Consultation with an expert in pediatric HIV for regimen selection is recommended. Refer to UpToDate content on management of infants born to mothers with HIV for further details.
Δ Zidovudine should not be used for longer than 6 weeks in total.
◊ When the mother has a detectable HIV RNA viral load, the risk of HIV transmission from mother to infant through breastmilk is high. Refer to UpToDate content on management of infants born to mothers with HIV for suggested prophylactic regimens for the breastfed infant when the mother has detectable viral load.
