Updated Hotline Perinatal Exposure Guidelines Now Available

The Hotline has released updated guidelines for the care of infants with perinatal exposure to HIV. These guidelines were developed in conjunction with Dr. Ellen Chadwick and Dr. Ram Yogev, Directors, Section of Pediatric and Maternal HIV Infection at Ann & Robert H. Lurie Children’s Hospital of Chicago. These guidelines replace those previously released in June of 2015. The major changes to the Hotline guidelines include the following:

For all HIV exposed infants:

  • Updated criteria for determining an infant’s risk status.
  • Simplified weight-band dosing for zidovudine for infants > 35 weeks gestation at birth.
  • Total Nucleic Acid (TNA) test as an option for HIV testing of infants in addition to HIV DNA PCR and HIV RNA PCR tests.

For low-risk infants:

  • Zidovudine prophylaxis from birth through 4 weeks of age.

For high-risk infants:

  • Nevirapine 6mg/kg orally twice daily for infants > 37 weeks gestation at birth
  • Nevirapine 4 mg/kg orally twice daily for infants 34-<37 weeks gestation at birth
  • Lamivudine 2 mg/kg orally twice daily ≥ 32 weeks gestation at birth
  • HIV testing of infants at birth, > 2 weeks of age, > 8 weeks of age, > 4 months of age

The Hotline guidelines are consistent with the federal Perinatal Guidelines with the exception of the Hotline’s recommendation for three-drug combination antiretroviral prophylaxis for all infants meeting high-risk criteria. The federal Perinatal Guidelines, in addition to a three-drug regimen, also provide the option of a two-drug (zidovudine/nevirapine) regimen for high-risk infants.

The complete Hotline guidelines and a video overview of the recent changes are available here.