{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T20:02:04Z","timestamp":1762459324478,"version":"3.41.2"},"reference-count":49,"publisher":"Wiley","issue":"7S6","license":[{"start":{"date-parts":[[2015,12,2]],"date-time":"2015-12-02T00:00:00Z","timestamp":1449014400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2015,12]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>There is new emphasis on identifying and treating HIV in the first days of life and also an appreciation that low birth weight (LBW) and preterm delivery (PTD) frequently accompany HIV\u2010related pregnancy. Even in the absence of HIV, PTD and LBW contribute substantially to neonatal and infant mortality. HIV\u2010exposed and \u2010infected infants with these characteristics have received little attention thus far. As HIV programs expand to meet the 90\u201090\u201090 target for ending the HIV pandemic, attention should focus on newborn infants, including those delivered preterm or of LBW.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>In high prevalence settings, infant diagnosis of HIV is usually undertaken after the neonatal period. However, as <jats:italic>in utero<\/jats:italic> infection may be diagnosed at birth, earlier initiation of therapy may limit viral replication and prevent early damage. Globally, there is growing awareness that preterm and LBW infants constitute a substantial proportion of births each year. Preterm infants are at high risk for vertical transmission. Feeding difficulties, apnoea of prematurity and vulnerability to sepsis occur commonly. Feeding intolerance, a frequent occurrence, may compromise oral administration of medications. Although there is growing experience with post\u2010exposure prophylaxis for HIV\u2010exposed term newborn infants, there is less experience with preterm and LBW infants. For treatment, there are even fewer options for preterm infants. Only zidovudine has adequate dosing recommendations for treating term and preterm infants and has an intravenous formulation, essential if feeding intolerance occurs. Nevirapine dosing for prevention, but not treatment, is well established for both term and preterm infants.<\/jats:p><jats:p>HIV diagnosis at birth is likely to be extremely stressful for new parents, more so if caring for preterm or LBW infants. Programs need to adapt to support the medical and emotional needs of young infants and their parents, where interventions may be lifesaving.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>New focus is required for the newborn baby, including those born preterm, with LBW or small for gestational age to consolidate gains already made in early diagnosis and treatment of young children.<\/jats:p><\/jats:sec>","DOI":"10.7448\/ias.18.7.20271","type":"journal-article","created":{"date-parts":[[2015,12,2]],"date-time":"2015-12-02T10:54:41Z","timestamp":1449053681000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["The last and first frontier \u2013 emerging challenges for HIV treatment and prevention in the first week of life with emphasis on premature and low birth weight infants"],"prefix":"10.1002","volume":"18","author":[{"given":"Mark F","family":"Cotton","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandi","family":"Holgate","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aurelie","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helena","family":"Rabie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Wedderburn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Mirochnick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,12,2]]},"reference":[{"volume-title":"The first 10 years","author":"UNAIDS (2008)","key":"e_1_2_7_2_1"},{"volume-title":"90\u201090\u201090 \u2013 an ambitious treatment target to help end the AIDS epidemic","author":"UNAIDS (2014)","key":"e_1_2_7_3_1"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0800971"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.17.1.18914"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e318290622e"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0125525"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199704000-00005"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1086\/314551"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3282f3d63c"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1108275"},{"key":"e_1_2_7_12_1","unstructured":"Guidelines for the use of antiretroviral agents in pediatric HIV infection"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32835cffb1"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu432"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1302976"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1413931"},{"key":"e_1_2_7_17_1","unstructured":"Care of the preterm and\/or low\u2010birth\u2010weight newborn"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60820-4"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001292"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.7196\/SAMJ.7200"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e318270097e"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-10-S1-S2"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(13)70006-8"},{"key":"e_1_2_7_24_1","unstructured":"Approach to the child with IUGR\/SGA. 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