EACS 2019 – Is it time to think about discontinuing neonatal post-exposure prophylaxis?


  • Cristina Ferrario — Agenzia Zoe
  • Conference Reports
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Takeaway

  • In Switzerland, since 2016 neonatal post-exposure prophylaxis (neoPEP) is no longer recommended in HIV exposed newborns if maternal HIV plasma viral load (pVL) is fully suppressed in the last trimester.
  • The new recommendations have been implemented rapidly, leading to an 86.4% reduction of NeoPEP exposure.
  • No mother-to-child-transmission (MTCT) of HIV was observed in the absence of neoPEP.
  • NeoPEP recommendations of other high-income countries should be reconsidered.

Why this matters?

  • In the era of highly active antiretroviral therapy (HAART) the rate of HIV MTCT is below 2% in high-income countries.
  • Concerns about neoPEP use are on the rise because the treatment is not strongly evidence-based and it is highly toxic.

Study design

  • Analysis of data from the Swiss Mother and Child HIV Cohort Study (MoCHiV) and the linked Swiss HIV Cohort Study (SHCS) database.
  • Children born between 2010 and 2018 were included if maternal HIV pVL in the last trimester data were available.
  • Comparison of frequencies of neoPEP in infants born before and after the new recommendations.
  • HIV-status assessment in children at 6 months of age.

Key results

  • Maternal HIV pVL in the last trimester:
  • NeoPEP administered to all children (n=20) with detectable maternal pVL in the third trimester.
  • NeoPEP used in 98.9% and 12.5% of children with undetectable maternal pVL born before and after the guideline change in 2016, respectively.
  • Of the 87 children who did not receive neoPEP, none were infected with HIV.

Limitations  

  • Small numbers