Leading the way: Penta’s collaboration in shaping European HIV Treatment Guidelines for children and pregnant people

15 May, 2024

By Alasdair Bamford and Anna Turkova, senior researchers at MRCCTU at University College London and Penta ID Network members

The 2023 revision to the European HIV guidelines marked the 3rd year of this successful collaboration between Penta and the European AIDS Clinical Society. This partnership aims to harmonise HIV treatment practice across Europe and between paediatric and adult care.

The updated paediatric section reflects advancements in the field. It provides guidance on new first-line treatment options for children, considers pre-exposure prophylaxis (PrEP) and long-acting agents in adolescents, and revises guidance on dual therapy and HIV/tuberculosis co-infection.

The most significant addition is a postnatal prophylaxis (PNP) and infant feeding section. While acknowledging regional variations, the Guidelines provide general principles on transmission risk stratification, choice and duration of infant PNP, infant feeding decisions (including supported breastfeeding under specific criteria), and infant HIV testing and monitoring. It is highlighted that in some countries, infant PrEP is offered for the duration of supported breastfeeding; in others, the usual post-birth regimen is recommended. Multidisciplinary team support is crucial throughout, especially during challenges like detectable maternal viral load or mastitis. 

As in previous versions, the Guidelines offer a link to the Penta Perinatal Virtual Clinic (PVC) for consultations and an updated concise dosing table available on the Penta website. The PVC welcomes referrals regarding optimising HIV treatment in children, adolescents and young adults, antenatal and postnatal management for preventing vertical HIV transmission, post-exposure prophylaxis and PrEP. Since 2017 more than 550 cases have been discussed, one-fifth from low/middle-income settings with data presented in 2024 at the Conference on Retroviruses and Opportunistic Infections (CROI) and the British HIV Association (BHIVA) conference. Cases are anonymised and the monthly online meeting is open, providing both support in clinical decision making and ongoing medical education. To know more about how to refer a case for discussion, visit Chiva | Perinatal Virtual Clinic or email caroline.foster5@nhs.net

A summary of the major update has been published https://onlinelibrary.wiley.com/doi/10.1111/hiv.13542)