Hotline Releases Updated Guidelines for Care of Infants with Perinatal Exposure to HIV

On August 28, 2019, the 24/7 Illinois Perinatal HIV Hotline released an update to their Best Practices for Care of Infants with Perinatal Exposure to HIV. These guidelines for Illinois replace the Hotline guidelines previously released in April of 2017.

These updated guidelines were developed in conjunction with Dr. Ellen Chadwick and Dr. Jennifer Jao, Directors, Section of Pediatric and Maternal HIV Infection at Ann & Robert H. Lurie Children’s Hospital of Chicago and Dr. Julia Rosebush, Director of Pediatric/Adolescent HIV at Comer Children’s Hospital of Chicago. They were adapted from the U.S Department of Health and Human Services Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States.

The major changes to the Hotline’s Best Practices for Care of Infants with Perinatal Exposure to HIV include the following:

For all infants with HIV exposure:

  • Simplified weight-band dosing for zidovudine for infants > 35 weeks gestation at birth and elimination of the 4mg/kg/dose Q12 recommendation.

For high-risk infants:

  • Administration of Nevirapine and 3TC for 2 weeks if birth PCR is negative, then discontinue.
  • Administration of Nevirapine and 3TC for beyond 2 weeks and consult a pediatric HIV specialist if birth PCR is positive.
  • Option to use Raltegravir instead of Nevirapine for high-risk infant prophylaxis (e.g., cases where mother has known viral resistance to Nevirapine or Efavirenz, Nevirapine is not available, etc.) and dosing recommendations.
    • Recommendation for clinicians to carefully review proper instructions for Raltegravir preparation and dosing and weigh the complexity of Raltegravir preparation/dosing with the benefits of its administration.
    • Recommendation for consultation with an expert in pediatric HIV in cases where Raltegravir will be used.