- 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.
- 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.
- 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.
- Small numbers