{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T20:05:32Z","timestamp":1784664332705,"version":"3.55.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"7","funder":[{"DOI":"10.13039\/100007890","name":"University of North Carolina at Chapel Hill","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007890","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Gillings School of Global Public Health","award":["203638807"],"award-info":[{"award-number":["203638807"]}]},{"name":"WHO HIV Guidelines Committee"},{"DOI":"10.13039\/100009633","name":"NIH\/NICHD","doi-asserted-by":"publisher","award":["K23HD109056"],"award-info":[{"award-number":["K23HD109056"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Preventing the postnatal transmission of HIV remains an unfinished goal globally. Infant antiretroviral (ARV) prophylaxis remains important, particularly when maternal viral suppression is not assured. We conducted a systematic review to identify optimal infant ARV prophylaxis to inform World Health Organization 2025 guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, and Global Index Medicus were searched for randomized controlled trials published in 2014-2024 evaluating ARVs given to infants to prevent postnatal HIV transmission. Eligible articles from prior systematic reviews from 1994 to 2014 were also reviewed. Two risk periods were considered: (1) the early postnatal period from delivery to 6 weeks of age, and (2) during breastfeeding from 6 weeks to 12\u00a0months. Scenarios were defined as higher risk when the mother was not on ART and lower risk when mothers were on ART.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We screened 1670 studies and reviewed 70 full-text articles. Nine trials (16\u2009279 infants) met eligibility criteria. In 5 studies addressing high-risk scenarios in the early postnatal period, use of 3 drugs for infant prophylaxis for 1 week followed by a single drug through 6 weeks resulted in 0.1% HIV transmission risk; 2 drugs through 6 weeks resulted in 1.5% risk; and 1 drug alone through 6 weeks, 2.5%-8.2% risk. In 6 studies addressing higher-risk scenarios during breastfeeding, single-drug prophylaxis throughout breastfeeding resulted in &amp;lt;1%-1.5% transmission risk at 12\u00a0months. No studies evaluated infant prophylaxis in lower-risk early postnatal scenarios. In low-risk breastfeeding scenarios, 6 weeks of infant prophylaxis resulted in &amp;lt;1% risk at 12\u00a0months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In higher-risk scenarios, trial data show that infants have the lowest risk of HIV transmission during the early postnatal period when they receive 2 weeks of 3 ARV drugs followed by a single drug through 6 weeks. Afterward, single-drug prophylaxis throughout breastfeeding demonstrates the lowest transmission risk at 12\u00a0months.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jpids\/piag051","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:43:28Z","timestamp":1782917008000},"source":"Crossref","is-referenced-by-count":0,"title":["A Systematic Review of the Use of Antiretroviral Drugs to Prevent HIV in Neonates and Infants"],"prefix":"10.1093","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1492-5090","authenticated-orcid":false,"given":"Lisa L","family":"Abuogi","sequence":"first","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus , Aurora, CO ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James G","family":"Carlucci","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Indiana University School of Medicine , Indianapolis, IN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6768-0096","authenticated-orcid":false,"given":"Andrew","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, NC ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Regula","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, NC ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandita","family":"Sugandhi","sequence":"additional","affiliation":[{"name":"World Health Organization , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8599-1004","authenticated-orcid":false,"given":"Dwight E","family":"Yin","sequence":"additional","affiliation":[{"name":"Maternal Adolescent and Pediatric Research Branch, Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Rockville, MD ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie K","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, NC ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"2026072115264113100_ref1","volume-title":"The Urgency of Now AIDS at a Crossroads: 2024 Global AIDS Update","author":"Joint United Nations Programme on HIV\/AIDS (UNAIDS)","year":"2024"},{"key":"2026072115264113100_ref2","volume-title":"Elimination of Mother-to-Child Transmission","author":"United Nations Children's Fund (UNICEF)","year":"2024"},{"key":"2026072115264113100_ref3","volume-title":"Global HIV & AIDS Statistics \u2014 Fact Sheet","author":"World Health Organization (WHO)","year":"2025"},{"key":"2026072115264113100_ref4","first-page":"Cd003510","article-title":"Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection","author":"Brocklehurst","year":"2002","journal-title":"Cochrane Database Syst Rev"},{"key":"2026072115264113100_ref5","doi-asserted-by":"publisher","first-page":"Cd003510","DOI":"10.1002\/14651858.CD003510.pub3","article-title":"Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection","volume":"2011","author":"Siegfried","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2026072115264113100_ref6","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1111\/j.1365-2710.2007.00825.x","article-title":"Systematic review of the efficacy of antiretroviral therapies for reducing the risk of mother-to-child transmission of HIV infection","volume":"32","author":"Suksomboon","year":"2007","journal-title":"J Clin Pharm Ther"},{"key":"2026072115264113100_ref7","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1056\/NEJM199411033311801","article-title":"Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. 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