Prevention of HIV Mother to Child Transmission: A review

Major advances have been made in the prevention of HIV mother to child transmission (MTCT) including shorter, less expensive, antiretroviral (ARV) regimens for the developing world. In 1994, ACTG 076 using long course AZT during pregnancy reduced MTCT by 68%. Subsequently oral AZT regimens starting at 35-36 weeks gestations have also reduced transmission by 50% in non-breast feeding populations and 30% in breast feeding cohorts. Combination therapy is more effective than monotherapy and pregnant women on HAART with an undetectable viral load have vertical transmission rates less than two percent. Elective caesarian section reduces vertical transmission rates independent of ARV therapy. However the risk of surgery in HIV-infected pregnant women must be weighed against the benefit of caesarian section.Vaginal antiseptic cleansing and nutritional interventions have not been shown to reduce MTCT, but are reported to reduce maternal and neonatal morbidity and mortality. Single dose NVP at the onset of labor and a single dose to the infant (HIVNET 012) led to a 42% reduction in transmission, providing the developing world with a simple and cheap regimen. However, most developing countries are not able to implement prevention programs on a large scale because of inadequate infrastructure, limited access to voluntary couhseling and testing (VCCT), insufficient community involvement and lack of infant feeding options. Exclusive breast-feeding may provide protection against acquisition of HIV through breast milk in these populations. Despite these advances in prevention of perinatal transmission there is still a need for further research, including operational research to improve implementation of successful interventions.