December 19, 2024: The Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV (the Panel) has reviewed and updated text and references of the Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. 

Infant Feeding for Individuals With HIV in the United States 

• Although the Guidelines use the term “breastfeeding” to describe feeding a child one’s own milk, the Panels recognize the importance of assessing and using individuals’ preferred terminology; some individuals may prefer using the term “chestfeeding” rather than “breastfeeding.”
• Bulleted recommendations now include information from the text on counseling about the infant feeding options of formula feeding, use of banked donor milk, or breastfeeding. Recommendations also address clinical management if the breastfeeding parent develops viremia. 

Diagnosis of HIV Infection in Infants and Children 

• Section text and Table 3. Recommended Virologic Testing Schedules for Infants With Perinatal and Breastfeeding Exposure to HIV have been revised to align with changes in Antiretroviral Management of Infants With In Utero, Intrapartum, or Breastfeeding Exposure to HIV.
• The Panels recommend virologic diagnostic testing at birth using an HIV nucleic acid test, which should generally be performed for all infants with perinatal HIV exposure but is not necessary for infants at low risk of HIV acquisition (defined as being born to a person who had HIV RNA levels <50 copies/mL from 20 weeks of gestation through delivery). Birth testing should be performed in infants at low risk of HIV acquisition if the parent plans to breastfeed or there are concerns about loss to follow-up (BIII). 

Antiretroviral Management of Infants With In Utero, Intrapartum or Breastfeeding Exposure or HIV Infection 

• This section has been extensively revised, and the title has been updated to reflect changes in recommendations, associated content about infant ARV management according to risk from in utero and intrapartum HIV exposure, and guidance for infant ARV prophylaxis during breastfeeding.
• The Panel revised the criteria for infant risk of HIV infection from in utero or intrapartum exposure and recommended ARV management.