Optimal anti-retroviral prophylaxis in infants at high-risk of acquiring human immunodeficiency virus: A systematic review

INTRODUCTION: The risk of perinatal HIV infection can be dramatically reduced through maternal antiretroviral therapy (ART) and infant antiretroviral (ARV) postnatal prophylaxis. The 2013 WHO guidelines recommended four to six weeks of nevirapine or zidovudine as post-natal prophylaxis, with possible extension to 12 weeks for high-risk breastfed infants. A systematic review was undertaken to determine if there is evidence for the WHO to recommend enhanced or extended prophylaxis for high-risk infants. METHODS: Cochrane CENTRAL, EMBASE, PubMed databases from 2005-2015, as well as CROI and IAS abstracts were searched. Cohort studies and randomized controlled trials (RCTs) examining the use of combination or prolonged regimens in HIV-exposed infants were included. 1185 studies were screened by title and abstract and 45 full-text articles were examined in further detail. RESULTS AND DISCUSSION: Of the four included studies, three examined multi-drug prophylaxis regimens in formula-fed, high-risk, HIV-exposed infants. Multi-drug regimens were shown to significantly reduce transmission rates, compared to single-drug regimens; however, there was no significant difference between two- and three-drug regimens. An RCT examining prolonged ARV prophylaxis in a breastfed population showed that six months of nevirapine resulted in lower HIV transmission rates compared to a standard six-week nevirapine regimen. CONCLUSIONS: The limited available evidence suggests that using combination ARV regimens in high-risk infants reduces intrapartum transmission and that using prolonged prophylaxis in breastfed infants reduces breastfeeding transmission rates. However, the additional benefit of combination or prolonged regimens in the context of maternal ART remains unclear

• Population(s)
  • Children or Youth (less than 18 years old)
  • General HIV- population
• Prevention
  • Biomedical interventions