Current issues in prevention of mother-to-child transmission of HIV-1

Doris Duke Medical Research Institute, Nelson Mandela School of Medicine, University of Kwazulu-Natal, 719 Umbilo Road, Congella, South Africa 4013, South Africa.
Current opinion in HIV and AIDS (Impact Factor: 4.39). 08/2009; 4(4):319-24. DOI: 10.1097/COH.0b013e32832a9a17
Source: PubMed

ABSTRACT To review new evidence in prevention of mother-to-child-transmission of HIV-1, which establishes, in principle, the feasibility of greatly improved effectiveness in developing countries.
This review presents evidence that demonstrates that a large gap in prevention of mother-to-child-transmission [MTCT] is being increasingly bridged. Recent studies have addressed issues on postnatal transmission of HIV-1 through breastfeeding. Breastfeeding transmission affects the majority of HIV-infected pregnant women and children in the world and who live in Africa and are often poor. Prevention of unwanted pregnancies in all women living in high HIV prevalence regions will probably reduce the risk of HIV-positive pregnancies. These studies demonstrate the success of the following three types of interventions:primary prevention of HIV-1 in women;prophylaxis with antiretroviral drugs in breastfeeding infants;prophylaxis with antiretroviral drugs for lactating mothers.It is also clear that key barriers to implementing these findings in developing countries are weak and ineffectual health systems. Therefore, identifying needs for improving health service delivery are critical; an example of the synergy between prevention and treatment through integrated services is given.
Recent data on primary prevention of HIV-1 in women of child-bearing age, and use of antiretrovirals in breastfeeding infants and lactating mothers, report successful interventions for the prevention of breastfeeding transmission of HIV-1. Health infrastructure improvement in developing countries is central to the application of research findings to implementation of MTCT programmes.

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    • "However, most of the evidence for recommending breastfeeding in developing countries comes from clinical trials performed in Sub-Saharan Africa. Data of formula feeding on child growth and mortality from PMTCT programmes in other continents are scarce, and some developing countries are supporting the use of formula feeding in their national PMTCT programmes [7] [8] [9] [10] [11]. India is the third country in the world in terms of HIV infected people, and it is estimated that 43,000 pregnant women were living with HIV in India in 2009 [12]. "
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    ABSTRACT: We describe a programme for the prevention of mother-to-child transmission (PMTCT) of HIV that provided universal antiretroviral therapy (ART) to all pregnant women regardless of the CD4 lymphocyte count and formula feeding for children with high risk of HIV transmission through breastfeeding in a district of India. The overall rate of HIV transmission was 3.7%. Although breastfeeding added a 3.1% additional risk of HIV acquisition, formula-fed infants had significantly higher risk of death compared to breastfed infants. The cumulative 12-month mortality was 9.6% for formula-fed infants versus 0.68% for breastfed infants. Anthropometric markers (weight, length/height, weight for length/height, body mass index, head circumference, mid-upper arm circumference, triceps skinfold, and subscapular skinfold) showed that formula-fed infants experience severe malnutrition during the first two months of life. We did not observe any death after rapid weaning at 5-6 months in breastfed infants. The higher-free-of HIV survival in breastfed infants and the low rate of HIV transmission found in this study support the implementation of PMTCT programmes with universal ART to all HIV-infected pregnant women and breastfeeding in order to reduce HIV transmission without increasing infant mortality in developing countries.
    06/2012; 2012:763591. DOI:10.5402/2012/763591
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    ABSTRACT: As life expectancy for HIV-infected persons improves, studies in sub-Saharan Africa show that a considerable proportion of HIV-positive women and men desire to have children. Integrating sexual and reproductive health care into HIV services has until now emphasized the right of women to make informed choices about their reproductive lives and the right of self-determination to reproduce, but this is often equated with avoidance of pregnancy. Here, we explore guidance and attention to safer conception for HIV-infected women and men. We find this right lacking. Current sexual and reproductive health guidelines are not proactive in supporting HIV-positive people desiring children, and are particularly silent about the fertility needs of HIV-infected men and uninfected men in discordant partnerships. Public health policymakers and providers need to engage the HIV-infected and uninfected to determine both the demand for and how best to address the need for safer conception services.
    Journal of Public Health Policy 12/2009; 30(4):367-78. DOI:10.1057/jphp.2009.35 · 1.75 Impact Factor
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    ABSTRACT: The purpose of the study was to review recent evidence on the use of antiretrovirals during pregnancy and breastfeeding in low-income and middle-income settings. Access to antiretroviral prophylaxis strategies for HIV-infected pregnant women has increased globally, but two-thirds of women in need still do not receive even the simplest regimen for the prevention of mother-to-child transmission of HIV, and most pregnant women in need of antiretroviral treatment do not receive it. The use of combination antiretroviral treatment in pregnancy in low-resource settings is safe and effective, and increasing evidence supports starting ongoing antiretroviral treatment at a CD4 cell count below 350/microl in pregnant women. The use of appropriate short-course antiretroviral prophylactic regimens is effective for prevention of mother-to-child transmission of HIV in women with higher CD4 cell counts. New data on the use of antiretroviral prophylaxis to prevent transmission through breastfeeding demonstrate that both maternal antiretroviral treatment and extended infant prophylaxis are effective. Antiretroviral use in pregnancy can benefit mothers in need of treatment and reduce the risk of mother-to-child transmission. Emerging evidence of the effectiveness of antiretroviral prophylaxis in preventing transmission through breastfeeding is encouraging and likely to influence practice in the future.
    Current opinion in HIV and AIDS 01/2010; 5(1):48-53. DOI:10.1097/COH.0b013e328333b8ab · 4.39 Impact Factor
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