A neonate born to an HIV-positive mother who received no ART during pregnancy is tested at 6 weeks of age. The HIV DNA PCR is negative. What is the MOST appropriate next step regarding antiretroviral prophylaxis and re-testing?
- A Continue nevirapine for 6 weeks; retest HIV DNA PCR at 6 weeks, 3 months, and 6 months ✓
- B Discontinue nevirapine; retest with HIV DNA PCR at 6 months
- C Switch to zidovudine; confirm with HIV antibody at 18 months
- D Start full ART immediately given maternal exposure risk
Explanation
Per NACO/WHO 2021 PMTCT guidelines, high-risk exposed neonates (mother with no ART or viral load >1000 copies/mL near delivery) receive extended nevirapine (NVP) prophylaxis for 6 weeks. A single negative HIV DNA PCR at 6 weeks does not exclude infection because viremia may peak later; guidelines recommend retesting at 6 weeks (or first contact), 3 months, and 6 months after cessation of breastfeeding. If breastfeeding, testing continues at 6 weeks after breastfeeding ends. Switching to zidovudine is not the current recommendation. Starting full ART is reserved for infants confirmed to have HIV infection. A negative 6-week PCR with no breastfeeding allows a presumptive exclusion but must be confirmed at 18 months with HIV antibody testing.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.