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HIV in Infants and ChildrenQuestion 1/5

A 9-week-old boy diagnosed with HIV is seen in a clinic for follow-up evaluation after a new HIV diagnosis. The child was born to a mother who was diagnosed with HIV at the time of delivery. The infant was prescribed a 6-week course of three-drug antiretroviral prophylaxis after birth, but there were concerns about the number of doses the infant actually received. Four days ago, the infant’s HIV RNA test was positive. Repeat testing 2 days later was also positive. Baseline laboratory studies for the infant showed a CD4 count of 1,038 cells/mm3, CD4 percentage of 29%, and an HIV RNA level of 147,900 copies/mL. An HIV genotypic drug resistance test is ordered.

Which one of the following is the most appropriate management for the infant?

In this clinical trial, investigators randomized infants with HIV and 6 to 12 weeks of age to receive early antiretroviral therapy versus deferred therapy (based on CD4-related criteria). As shown in this graph, the group in the deferred treatment group (orange bars) had a significantly higher rate of death and disease progression than those who received early treatment (blue bars).
Figure 1. Death and Disease Progression in Infants Receiving Early or Deferred Antiretroviral Therapy
In this clinical trial, investigators randomized infants with HIV and 6 to 12 weeks of age to receive early antiretroviral therapy versus deferred therapy (based on CD4-related criteria). As shown in this graph, the group in the deferred treatment group (orange bars) had a significantly higher rate of death and disease progression than those who received early treatment (blue bars).
Source: Violari A, Cotton MF, Gibb DM, et al. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med. 2008;359:2233-44.
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Question Last Updated
August 19th, 2026

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