ObjectivesThis survey was conducted to describe current European postnatal prophylaxis (PNP) and infant feeding policies with the aim of informing future harmonized guidelines.MethodsA total of 32 senior clinicians with relevant expertise, working in 20 countries within the European Region, were invited to complete a REDCap questionnaire between July and September 2023.ResultsTwenty-three of the 32 invited paediatricians responded, representing 16/20 countries. There were multiple respondents from the same country for Italy (n = 5), the UK (n = 2), Germany (n = 2) and France (n = 2). All countries use risk stratification to guide PNP regimen selection. Nine out of 16 countries reported three risk categories, six out of 16 reported two, and one country reported differences in categorization. Criteria used to stratify risk varied between and within countries. For the lowest risk category, the PNP regimen reported ranged from no PNP to up to four weeks of one drug; the drug of choice reported was zidovudine, apart from one country which reported nevirapine. For the highest risk category, the most common regimen was zidovudine/lamivudine/nevirapine (20/23 respondents); regimen duration varied from two to six weeks with variation in recommended dosing. Guidelines support breastfeeding for infants born to people living with HIV in eight out of 16 countries; in the other eight, guidelines do not support/specify.ConclusionsGuidelines and practice for PNP and infant feeding vary substantially across Europe and within some countries, reflecting the lack of robust evidence. Effort is needed to align policies and practice to reflect up-to-date knowledge to ensure the vertical transmission risk is minimized and unnecessary infant HIV testing and PNP avoided, while simultaneously supporting families to make informed decisions on infant feeding choice.
[1]UCL Great Ormond St Inst Child Hlth, Populat Policy & Practice Res & Teaching Dept, London WC1N 1EH, England.
[2]MRC Clin Trials Unit UCL, London, England.
[3]Univ Libre Bruxelles, Hop St Pierre, Brussels, Belgium.
[4]Childrens Hosp Eastern Switzerland, Infect Dis & Hosp Epidemiol, St Gallen, Switzerland.
[5]Riga East Univ Hosp, Latvian Ctr Infect Dis, Outpatient Dept, Riga, Latvia.
[6]Bambino Gesu Pediat Hosp, Univ Paediat Clin Area, Simplex Unit Perinatal & Complex Infect Dis, Rome, Italy.
[7]Meyer Childrens Univ Hosp IRCCS, Infect Dis Unit, Florence, Italy.
[8]Hop Trousseau, AP HP, Serv Hematooncol Pediat, Paris, France.
[9]Univ Paris Cite, Grp Hosp AP HP Ctr, Necker Enfants Malad Hosp, Lab Clin Microbiol, Paris, France.
[10]Childrens Hlth Ireland, Dept Paediat Infect Dis, Dublin, Ireland.
[11]Univ Coll Dublin, Sch Med, CEPHR, Dublin, Ireland.
[12]Univ Milan, L Sacco Hosp, Dept Paediat, Paediat Infect Dis Unit, Milan, Italy.
[13]Tel Aviv Sourasky Med Ctr, Dana Childrens Hosp, Pediat Infect Dis Unit, Tel Aviv, Israel.
[14]Goethe Univ, Univ Hosp Frankfurt, Dept Paediat & Adolescent Med, Frankfurt, Germany.
[15]Imperial Coll Healthcare NHS Trust, Paediat Infect Dis, London, England.
[16]Med Univ Warsaw, Dept Childrens Infect Dis, Warsaw, Poland.
[17]Natl Inst Infect Dis Prof Dr Matei Bals, Pediat Dept, Bucharest, Romania.
[18]Karolinska Inst, Karolinska Univ Hosp, Dept Clin Sci Intervent & Technol Clintec, SE-14186 Stockholm, Sweden.
[19]Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Pediat, Stockholm, Sweden.
[20]Helios Klinikum Krefeld, Dept Pediat, Krefeld, Germany.
[21]Hosp St Joan de Deu, Inst Recerca St Joan de Deu, Pediat Infect Dis Dept, Infect Dis & Syst Inflammatory Response Pediat, Barcelona, Spain.
[22]CIBERESP, Madrid, Spain.
[23]Univ Barcelona, Fac Med & Ciencies Salut, Dept Cirurgia & Especialitats Medicoquirurg, Barcelona, Spain.
[24]Radboud Univ Nijmegen Med Ctr, Amalia Childrens Hosp, Dept Pediat, Nijmegen, Netherlands.
[25]Shupyk Natl Healthcare Univ Ukraine, Dept Pediat Pediat Infect Dis Immunol & Allergol, Kiev, Ukraine.
[26]Univ Hosp Birmingham NHS Fdn Trust, Dept Diabet, Birmingham, England.
[27]Great Ormond St Hosp Children NHS Fdn Trust, Dept Paediat Infect Dis, London, England.
[28]UCL Great Ormond St Inst Child Hlth, Infect Immun & Inflammat Res & Teaching Dept, London, England.
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