Question

A neonate is born to an HIV-positive mother with a viral load of 1200 copies/mL. What is the recommended antiretroviral prophylaxis for the newborn?

• A. Nevirapine for 6 weeks with exclusive breastfeeding
• B. Nevirapine + Zidovudine for 6 weeks with exclusive breastfeeding
• C. No prophylaxis needed as mother is on ART
• D. Nevirapine + Zidovudine for 12 weeks with exclusive breastfeeding

Hint:

HIV-exposed neonate with higher transmission risk may need dual prophylaxis with Nevirapine and Zidovudine.

Answer 1

The Correct Option is D

Step 1: Understanding the Question:
The management of a neonate born to an HIV-positive mother depends on the mother's viral load at delivery. A high viral load (>1000 copies/mL) places the infant at "high risk" for vertical transmission.
Step 2: Detailed Explanation:

Risk Stratification: Standard guidelines (like NACO or WHO) categorize neonates. If the mother has a viral load < 1000 copies/mL, the infant is "low risk." If the viral load is $\geq$ 1000 copies/mL (as in this case with 1200), the infant is "high risk."

Low-Risk Prophylaxis: Typically involves single-drug prophylaxis (Nevirapine) for 6 weeks.

High-Risk Prophylaxis: Because the risk of intrapartum and postpartum transmission is elevated, dual-drug therapy is indicated. The recommended regimen is Nevirapine (NVP) plus Zidovudine (AZT).

Duration: In high-risk scenarios, the duration of prophylaxis is extended. Current guidelines often recommend dual therapy for 12 weeks to provide maximum protection during the early breastfeeding period.

Feeding Choice: Exclusive breastfeeding is strongly recommended for the first 6 months, as the benefits for the infant's overall health outweigh the risk of transmission when appropriate ARV prophylaxis is used. Mixed feeding (breast milk + other liquids) should be strictly avoided.

Step 3: Final Answer:
For a high-risk neonate (maternal VL > 1000), dual prophylaxis with Nevirapine + Zidovudine for 12 weeks is recommended.