{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:57:13Z","timestamp":1753869433439,"version":"3.41.2"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Presumptive HIV therapy (PHT) is recommended for post\u2010natal HIV prophylaxis (PNP) in situations at high risk of HIV vertical transmission (VT), for both prevention of transmission and as early treatment in cases of in utero transmission. The objective of this study was to describe the risk of VT and use PHT among newborns in Canada, and specifically, factors associated with the use of PHT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were analysed for all mother\u2010infant pairs (MIPs) in the Canadian Perinatal HIV Surveillance Program (1997\u22122020), collected annually from 22 perinatal HIV centres in Canada. Infants were categorized as high risk (delivery viral load [dVL] \u22651000 copies\/ml or maternal combined antiretroviral [cART] &lt;4 weeks prior to delivery), moderate risk (dVL detectable and &lt;1000 copies\/ml, and maternal cART \u22654 weeks prior to delivery) and low risk (dVL undetectable and maternal cART \u22654 weeks prior to delivery). Neonatal prophylaxis and HIV transmission risk were compared between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 4743 MIPs were included in the analysis. Overall, 13.3% of newborns received PHT; the most prescribed PHT regimens included combinations using zidovudine, lamivudine and nelfinavir (48.5%) or nevirapine (41.9%). While the most significant risk factor for transmission on univariate analysis was a detectable dVL \u22651000 copies\/ml versus undetectable (odds ratio [OR] 27.91 [11.20\u221269.54]), the risk remained significantly increased at dVL between 400 and 999 copies\/ml (OR 31.71 [8.31\u2212120.98], but not at dVL between 50 and 399 copies\/ml (OR 3.03 [0.72\u221212.81]). At dVL 50\u2013399 copies\/ml, 29.8% of infants received PHT, increasing to 46.7% at dVL 400\u2013999 copies\/ml, and 64.4% of infants at dVL\u22651000 copies\/ml. The overall risk of transmission was 6% in the high\u2010risk group, 0.5% in the moderate\u2010risk group and 0.2% in the low\u2010risk group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PHT has been widely used in Canada in situations at high risk of VT, with 25% of newborns in this risk group receiving PHT as PNP. While PHT may reduce the risk of VT in high\u2010risk situations and may be of benefit in cases of VT, these data also highlight ongoing gaps in perinatal HIV prevention in Canada.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26510","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T06:18:54Z","timestamp":1749017934000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postnatal prophylaxis and the use of presumptive HIV therapy for the prevention of vertical transmission of HIV in Canada 1997\u20132020"],"prefix":"10.1002","volume":"28","author":[{"given":"Jeanne","family":"Brochon","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Department of Pediatrics CHU Sainte Justine, Universit\u00e9 de Montr\u00e9al Montr\u00e9al Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terry","family":"Lee","sequence":"additional","affiliation":[{"name":"CIHR Pan\u2010Canadian Network for HIV &amp; STBBI Clinical Trials Research Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Brophy","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario, University of Ottawa Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel","family":"Singer","sequence":"additional","affiliation":[{"name":"CIHR Pan\u2010Canadian Network for HIV &amp; STBBI Clinical Trials Research Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie\u2010Elaine","family":"Metras","sequence":"additional","affiliation":[{"name":"Pharmacy Department CHU Sainte Justine, Universit\u00e9 de Montr\u00e9al Montr\u00e9al Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeannette","family":"Comeau","sequence":"additional","affiliation":[{"name":"IWK Health, Dalhousie University Halifax Nova Scotia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alena","family":"Tse\u2010Chang","sequence":"additional","affiliation":[{"name":"Stollery Children's Hospital, University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athena","family":"McConnell","sequence":"additional","affiliation":[{"name":"Jim Pattison Children's Hospital, University of Saskatchewan Saskatoon Saskatchewan Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Money","sequence":"additional","affiliation":[{"name":"Women's Hospital and Health Centre of British Columbia, University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9545-6024","authenticated-orcid":false,"given":"Isabelle","family":"Boucoiran","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine Department of Obstetrics and Gynecology Universit\u00e9 de Montr\u00e9al Montreal Quebec Canada"},{"name":"Women and Children Infectious Disease Center, Sainte\u2010Justine Research Center Montreal Quebec Canada"},{"name":"School of Public Health, Universit\u00e9 de Montr\u00e9al Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura J.","family":"Sauve","sequence":"additional","affiliation":[{"name":"Women's Hospital and Health Centre of British Columbia, University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5289-5430","authenticated-orcid":false,"given":"Ari","family":"Bitnun","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children, University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7408-4399","authenticated-orcid":false,"given":"Fatima","family":"Kakkar","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Department of Pediatrics CHU Sainte Justine, Universit\u00e9 de Montr\u00e9al Montr\u00e9al Quebec Canada"},{"name":"Women and Children Infectious Disease Center, Sainte\u2010Justine Research Center Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20180016"},{"key":"e_1_2_11_3_1","unstructured":"Public Health Agency of Canada. 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