The authors evaluated children aged younger than 18 years who were HIV-exposed but uninfected with at least one head circumference measurement while enrolled in the Surveillance Monitoring for ART Toxicities (SMARTT) study at 22 clinical sites in the USA, including Puerto Rico. These findings support consideration of alternatives to efavirenz as part of first-line antiretroviral therapy for pregnant women.


  1. Zash RM Williams PL Sibiude J Lyall H Kakkar F. Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges. Expert Opin Drug Saf. 2016; 15: 1501-1513

  2. WHO. Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV. WHO, Geneva, Switzerland2018

  3. Rosman NP Tarqui nio DC Datseris M et al. Postnatal-onset microcephaly: pathogenesis, patterns of growth, and prediction of outcome. Pediatrics. 2011; 127: 665-671


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