Novel Approaches to Postnatal Prophylaxis to Eliminate Vertical Transmission of HIV

Theodore Ruel¹, Martina Penazzato², Jennifer M Zech³, Moherndran Archary⁴, Tim R Cressey⁵, Ameena Goga^{6

7}, Joseph Harwell⁸, Raphael J Landovitz⁹, Maria Grazia Lain¹⁰, Marc Lallemant^{11

12}, Eleanor Namusoke-Magongo¹³, Irene Mukui¹⁴, Sallie R Permar¹⁵, Andrew J Prendergast^{16

17}, Roger Shapiro¹⁸, Elaine J Abrams^{3

19}

Affiliations

¹ University of California, San Francisco, San Francisco, CA, USA.
² World Health Organization, Geneva, Switzerland.
³ ICAP at Columbia University, Mailman School of Public Health, Columbia University, NY, USA.
⁴ University of KwaZulu-Natal, Durban, South Africa.
⁵ AMS-IRD Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
⁶ HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
⁷ Department of Paediatrics and Child Health, University of Pretoria, South Africa.
⁸ Clinton Health Access Initiative, Boston, MA, USA.
⁹ UCLA Center for Clinical AIDS Research and Education, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
¹⁰ Fundação Ariel Glaser contra o SIDA Pediátrico, Maputo, Mozambique.
¹¹ AMS-PHPT Research Collaboration, Chiang Mai University, Chiang Mia, Thailand.
¹² Penta Foundation Italy, Padova, Italy.
¹³ Paediatric and Adolescent HIV Care Treatment Branch, Ministry of Health, Kampala, Uganda.
¹⁴ Drugs for Neglected Diseases Initiative, Nairobi, Kenya.
¹⁵ Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.
¹⁶ Queen Mary University of London, London, United Kingdom.
¹⁷ Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
¹⁸ Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁹ Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.

PMID: 37116934
PMCID: PMC10141432
DOI: 10.9745/GHSP-D-22-00401

Novel Approaches to Postnatal Prophylaxis to Eliminate Vertical Transmission of HIV

Theodore Ruel et al. Glob Health Sci Pract. 2023.

. 2023 Apr 28;11(2):e2200401.

doi: 10.9745/GHSP-D-22-00401. Print 2023 Apr 28.

Authors

Affiliations

¹ University of California, San Francisco, San Francisco, CA, USA.
² World Health Organization, Geneva, Switzerland.
³ ICAP at Columbia University, Mailman School of Public Health, Columbia University, NY, USA.
⁴ University of KwaZulu-Natal, Durban, South Africa.
⁵ AMS-IRD Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
⁶ HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
⁷ Department of Paediatrics and Child Health, University of Pretoria, South Africa.
⁸ Clinton Health Access Initiative, Boston, MA, USA.
⁹ UCLA Center for Clinical AIDS Research and Education, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
¹⁰ Fundação Ariel Glaser contra o SIDA Pediátrico, Maputo, Mozambique.
¹¹ AMS-PHPT Research Collaboration, Chiang Mai University, Chiang Mia, Thailand.
¹² Penta Foundation Italy, Padova, Italy.
¹³ Paediatric and Adolescent HIV Care Treatment Branch, Ministry of Health, Kampala, Uganda.
¹⁴ Drugs for Neglected Diseases Initiative, Nairobi, Kenya.
¹⁵ Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.
¹⁶ Queen Mary University of London, London, United Kingdom.
¹⁷ Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
¹⁸ Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁹ Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.

PMID: 37116934
PMCID: PMC10141432
DOI: 10.9745/GHSP-D-22-00401

Abstract

Despite progress in providing antiretroviral therapy to pregnant women living with HIV, a substantial number of vertical transmissions continue to occur. Novel approaches leveraging modern potent, safe, and well-tolerated antiretroviral drugs are urgently needed.

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Figures

**FIGURE 1**
Current Algorithm for HIV Transmission Risk Stratification^a ^aAdapted from: World Health Organization’s *Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach.*

**FIGURE 2**
Current Postnatal Prophylaxis Guidance for Infants at High Risk of HIV Transmission^a Abbreviations: AZT: zidovudine; NVP: nevirapine; ART: antiretroviral treatment. ^a Figure design based on guidance from: World Health Organization’s *Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach*.

**FIGURE 3**
Novel Approaches to Infant Postnatal Prophylaxis Abbreviations: ALD, abacavir plus lamivudine plus dolutegravir tablets; ALL, abacavir plus lamivudine plus lopinavir-ritonavir granules; bNabs, broadly neutralizing antibodies; LA ARV, long-acting antiretroviral drugs; LR, low-risk situations; HR, high-risk situations. ^a For premature babies, zidovudine and nevirapine should be used.

See this image and copyright information in PMC

References

1. Joint United Nations Programme on HIV/AIDS (UNAIDS). In Danger: UNAIDS Global AIDS Update 2022. UNAIDS; 2022. Accessed March 6, 2023. https://www.unaids.org/sites/default/files/media_asset/2022-global-aids-...
1. Differentiated MCH Services: CQUIN Differentiated Maternal and Child Health Workshop. November 2020. Videocast available at: https://cquin.icap.columbia.edu/event/mch-workshop
1. Joint United Nations Programme on HIV/AIDS (UNAIDS). Start Free, Stay Free, AIDS Free: Final Report on 2020 Targets. UNAIDS; 2021. Accessed March 6, 2023. https://www.unaids.org/sites/default/files/media_asset/2021_start-free-s...
1. World Health Organization (WHO). HIV Diagnosis and ARV Use in HIV-Exposed Infants: A Programmatic Update. WHO; 2018. Accessed March 6, 2023. https://apps.who.int/iris/bitstream/handle/10665/273155/WHO-CDS-HIV-18.1...
1. World Health Organization (WHO). Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach. WHO; 2021. Accessed March 6, 2023. https://www.who.int/publications/i/item/9789240031593 - PubMed

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Novel Approaches to Postnatal Prophylaxis to Eliminate Vertical Transmission of HIV

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Novel Approaches to Postnatal Prophylaxis to Eliminate Vertical Transmission of HIV

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