Perinatal HIV Exposure Management (for Breastfeeding and Non-Breastfeeding Newborns)

Pathway Background and Objectives

Human immunodeficiency virus (HIV) may be transmitted vertically from mother to newborn. Antiretroviral therapy (ARV) is effective in both preventing and treating HIV in perinatally exposed newborns. National guidelines from the National Institutes of Health and the Centers for Disease Control and Preventions were updated in 2024. These guidelines stress the following points. Infants do not all receive the same perinatal HIV medications and are rather stratified by risk based on maternal factors. Antiviral medication for infants should be started within 6 hours of birth. Additionally, the guidelines allow for women living with HIV to breastmilk feed their babies under certain criteria. It should be noted that prior to ARV, breastmilk feeding transmission of HIV was ~15-20% in the first 2 years of infant life. Breastmilk feeding has important benefits for both the infants and mothers, and given how effective ARV can be, women living with HIV should be counseled regarding feeding options for their babies. This clinical pathway is meant for use in the following settings: well-baby nursery, neonatal intensive care unit, pediatric inpatient unit, outpatient infectious diseases (ID) clinic, and primary care clinic. The specific objectives of the pathway are to:

  • Standardize management to align with national recommendations to prevent or treat HIV in infants exposed to HIV-infected mothers
  • Establish a standardized approach for counseling women living with HIV to support them in their decision about choice of infant feeding (mother's own milk, donor milk, or formula)
  • Standardize care to align with national recommendations to prevent HIV transmission to infants with mothers living with HIV who choose to breastmilk feed their infants

  • Facilitate pediatric ID outpatient care following the birth hospitalization

     

Algorithm  Educational Module

 

 

Under Development

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.