New developments in antiretroviral therapy strategies to improve clinical management of neonates and young infants with HIV.

Purpose of review: Clinical and virological outcomes in early-treated cohorts of children living with HIV have been sub-optimal. This is in part due to the demands on the caregiver of adhering to twice a day antiretroviral treatment (ART) for their newborn infants. Administering ART to neonates can be challenging and frequently requires separate drugs in liquid formulations and multiple dose adjustments. We reviewed literature from 01 January 2015 to 31 December 2024 on infant outcomes, antiretroviral drugs, updated dosing recommendations, new formulations and potential strategies to enhance adherence when ART is started in the neonatal and young infant period.

Recent findings: There are now pharmacokinetic (PK) data to inform the use of abacavir and lamivudine in liquid and solid formulations in the neonatal period and to support the use of lamivudine and nevirapine in preterm infants. A dosing strategy for dolutegravir in the first month of life has been informed by recent studies.

Summary: Studies are ongoing with regards to dolutegravir in various formulations. Long-acting antiretroviral therapy and broadly neutralizing antibodies are currently being studied in neonates and young infants. Addressing maternal clinical and psychosocial health and is a key factor in ensuring infants achieve viral suppression and decreased morbidity.