Human Immunodeficiency Virus Type 1 in the Premature Infant

Abstract

Prematurity and low birthweight are seen frequently in infants with human immunodeficiency virus (HIV) type 1 infection, adding significant comorbidities and complicating the approach to treatment. HIV disease progression accelerates in the setting of an immature immune system. Recent cases have underscored the unique opportunity to not only limit progression, but also limit the establishment of HIV reservoirs that impede viral clearance by starting antiretroviral treatment (ART) early in the neonatal period. Although pediatric ART alternatives are increasing, there are still only few available agents for the treatment of neonates, especially premature and low-birthweight infants. Zidovudine is the only agent for which there is sufficient experience in premature infants, while being an intravenous alternative for infants in whom enteric administration is not possible. Nevirapine has been studied for prophylactic dosing in preterm infants. It is imperative that resources are devoted to the study of the safety and efficacy of ARTs for use during the neonatal period.