HIV postnatal prophylaxis: how long is long enough?

Despite improvements in the prevention of HIV mother-to-child transmission in recent years, the elimination of pediatric HIV remains elusive. Extended postnatal prophylaxis (ePNP) could be key to achieving this goal.

Key questions surrounding timing of ePNP administration are: How long should ePNP be administered for? Should antiretroviral drugs with a long half-life be favored? Could ePNP be improved using long-acting injectable products adapted for use with neonates, infants, and children? In the search strategy (four databases), only articles published in English between 1990 and 2025 were included.

As there is a risk of HIV transmission throughout breastfeeding, if ePNP is initiated - guided or not by maternal HIV viral load -, it should be administered until breastfeeding has ceased completely. Determining the plasma/tissue level of antiretroviral drugs or broadly neutralizing HIV antibodies (bNAbs) required to protect against HIV acquisition through breastfeeding is a research priority. Long-acting antiretroviral drugs are currently unavailable for prophylaxis or treatment in neonates and children. Several studies are currently evaluating the safety and pharmacokinetics of bNAbs in neonates and children exposed to HIV. These bNAbs could represent a significant advance in the prevention of postnatal HIV acquisition in the future.