HIV postnatal prophylaxis and infant feeding policies vary across Europe: results of a Penta survey

Abstract

Objectives: This survey was conducted to describe current European postnatal prophylaxis (PNP) and infant feeding policies with the aim of informing future harmonized guidelines.

Methods: A total of 32 senior clinicians with relevant expertise, working in 20 countries within the European Region, were invited to complete a REDCap questionnaire between July and September 2023.

Results: Twenty-three of the 32 invited paediatricians responded, representing 16/20 countries. There were multiple respondents from the same country for Italy (n = 5), the UK (n = 2), Germany (n = 2) and France (n = 2). All countries use risk stratification to guide PNP regimen selection. Nine out of 16 countries reported three risk categories, six out of 16 reported two, and one country reported differences in categorization. Criteria used to stratify risk varied between and within countries. For the lowest risk category, the PNP regimen reported ranged from no PNP to up to four weeks of one drug; the drug of choice reported was zidovudine, apart from one country which reported nevirapine. For the highest risk category, the most common regimen was zidovudine/lamivudine/nevirapine (20/23 respondents); regimen duration varied from two to six weeks with variation in recommended dosing. Guidelines support breastfeeding for infants born to people living with HIV in eight out of 16 countries; in the other eight, guidelines do not support/specify.

Conclusions: Guidelines and practice for PNP and infant feeding vary substantially across Europe and within some countries, reflecting the lack of robust evidence. Effort is needed to align policies and practice to reflect up-to-date knowledge to ensure the vertical transmission risk is minimized and unnecessary infant HIV testing and PNP avoided, while simultaneously supporting families to make informed decisions on infant feeding choice.

Keywords: HIV; breastfeeding; paediatrics; policy; postnatal prophylaxis; vertical transmission.

FIGURE 1

Participation among countries in the WHO European Region.

FIGURE 2

Participating countries HIV polymerase chain reaction (PCR) testing schedule for non‐breastfed infants (13/16 countries provided a response). Key: This test will be performed only for infants classified as being at high risk of vertical transmission. a, if the infant is classified as high risk for vertical transmission, the respondent indicated that this test would instead be conducted 2 weeks after stopping presumptive therapy; b, if the infant is classified as high‐risk, the respondent indicated this test would instead be conducted at 2 weeks; c, one out of two respondents indicated testing at this time point was optional; d, one out of two respondents reported this time point to be 10–12 weeks if low‐risk, and 12 weeks if high‐risk; e, this time point was reported by one out of two respondents only; f, the respondent indicated the test at this time point would not be performed if there were two prior negative PCRs; g, the respondent indicated that testing at this timepoint would only be conducted if necessary.

FIGURE 3

Participating countries HIV polymerase chain reaction testing schedule for breastfed infants (10/16 countries provided a response). a, one out of two respondents reported this time point to be 2 weeks.