ARV prophylaxis in Infant born to a HIV positive mother

Scenario 1: Infant ARV prophylaxis when mother has not been taking Nevirapine during pregnancy 

Infants are to be given daily Nevirapine (NVP) from birth for 6 weeks regardless of the mode of feeding. The NVP duration is extended to 12 weeks if infants is on Exclusive breastfeeding or even if on mixed feeding. In cases where family decides for a 100% Replacement feeding and is not breastfeeding at all, prophylaxis for 6 weeks suffices.

Besides this, the duration of  NVP prophylaxis is also extended to 12 weeks, if ART to the mother was started less than 4 weeks before delivery.

Infant Nevirapine prophylaxis regimen

Infant age Daily dosing 
Birth* to 6 weeks Birth weight 2000- 2500 g Birth weight > 2500 g 10 mg (1 ml) once daily 15 mg (1.5 ml) once daily 
> 6 weeks – upto 6 months# 20 mg (2 ml) once daily 
> 6 months – upto 9 months# 30 mg (3 ml) once daily 
> 9 months – until breast feeding ends 40 mg (4 m) once daily 
*Infants weighing < 2000 g; the suggested starting dose is 2 mg/kg once daily # NVP dose for older infants is provided in a situation where HIV exposure is identified during infancy, the mother is breastfeeding and the infant is either HIV uninfected or the status is yet to be determined 

NVP prophylaxis can be started even if more than 72 hours have passed since birth though its efficacy in preventing perinatal transmission will be lower. It will, however, still be protective towards transmission by breastfeeding. 

Scenario 2: Infants of women with prior exposure to Nevirapine/ born to women with HIV-2 infection.

These infants should be given syrup Zidovudine in place of syrup Nevirapine

Dose of Zidovudine for infants

Infant Birth Weight AZT Daily Dosage in mg AZT Daily Dosage in ml 
< 2000 g 5mg/dose twice daily 0.5 ml twice daily 
2000- 2500 g 10mg/dose twice daily 1 ml twice daily 
> 2500 g 15mg/dose twice daily 1.5 ml twice daily 

Above matter adapted from Current NACO GuidelinesClick for Details

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