Assessment of HIV perinatal transmission risk

Australasian Society for Infections Diseases (ASID), 2022

Neonatal antiretroviral postexposure prophylaxis against HIV is complex and requires consultation with an HIV specialist with experience in perinatal transmission prevention.

Note: Neonatal antiretroviral prophylaxis is complex and requires consultation with an HIV specialist with experience in perinatal transmission prevention.

The duration of neonatal antiretroviral prophylaxis and the antiretrovirals recommended depends on whether the neonate is considered to be at very low risk, low risk or high risk of perinatal transmission; see Assessment of perinatal transmission risk for more information.

Table 1. Assessment of perinatal transmission risk
Australasian Society for Infections Diseases (ASID), 2022
Risk of perinatal transmission	Determination of risk
very low risk	Neonate born at 36 weeks gestation or more AND Birthing parent (eg mother) had: been taking combination antiretroviral therapy for 10 weeks or more before birth 2 viral loads of less than 50 HIV RNA copies/mL during pregnancy taken 4 weeks or more apart with one test at 36 weeks gestation or more. For regimens, see Antiretroviral prophylaxis regimens for neonates at very low risk of perinatal transmission of HIV.
low risk (estimated transmission risk less than 2%)	Neonate born before or after 36 weeks gestation AND Birthing parent had: a prebirth viral load of less than 50 HIV RNA copies/mL. For regimens, see Antiretroviral prophylaxis regimens for neonates at low risk of perinatal transmission of HIV.
high risk (estimated transmission risk more than 2%)	Neonate born before or after 36 weeks gestation AND Birthing parent had: a detectable viral load greater than 50 HIV RNA copies/mL near birth not received antepartum antiretroviral therapy (including those who only received intrapartum therapy) an unknown prebirth viral load. For regimens, see Antiretroviral prophylaxis regimens for neonates at high risk of perinatal transmission of HIV.