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HIV postnatal prophylaxis: how long is long enough?

Philippe Van de Perre1, Jean-Pierre Moles1, Nicolas Nagot1

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Summary

Extended postnatal prophylaxis (ePNP) is crucial for eliminating pediatric HIV. Research is ongoing to optimize ePNP duration and explore long-acting options for breastfeeding infants to prevent HIV transmission.

Keywords:
Prevention of vertical HIV transmissionbreastfeedingbroadly neutralizing antibodies (bNAbs)long acting antiretroviral drugspharmacologypostnatal prophylaxis (PNP)

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Area of Science:

  • Pediatric HIV prevention
  • Mother-to-child HIV transmission
  • Antiretroviral prophylaxis

Background:

  • Despite advances, pediatric HIV elimination remains a challenge.
  • Extended postnatal prophylaxis (ePNP) is a potential strategy.
  • HIV transmission risk persists throughout breastfeeding.

Purpose of the Study:

  • To review key questions regarding ePNP timing and formulation.
  • To explore the potential of long-acting antiretroviral products for neonates and children.
  • To identify research priorities for optimizing ePNP.

Main Methods:

  • Literature search conducted across four databases.
  • Inclusion of articles published in English between 1990 and 2025.
  • Review of expert opinions on ePNP and future prevention strategies.

Main Results:

  • ePNP should continue until breastfeeding cessation, regardless of maternal viral load.
  • Determining optimal antiretroviral drug or broadly neutralizing HIV antibody (bNAb) levels for breastfeeding protection is a priority.
  • Long-acting antiretroviral drugs for pediatric prophylaxis are currently unavailable.

Conclusions:

  • Long-acting antiretroviral drugs and bNAbs show promise for preventing postnatal HIV acquisition.
  • Further research into bNAb safety and pharmacokinetics in neonates and children is underway.
  • Optimizing ePNP is essential for achieving the goal of pediatric HIV elimination.