Impact of Antiretroviral Drugs in Pregnant Women and Their Children in Africa: HIV Resistance and Treatment Outcomes

IrsiCaixa AIDS Research Institute.
The Journal of Infectious Diseases (Impact Factor: 6). 06/2013; 207 Suppl 2(suppl 2):S93-S100. DOI: 10.1093/infdis/jit110
Source: PubMed


The global community has committed itself to eliminating new pediatric HIV infections by 2015 and improving maternal, newborn,
and child health and survival in the context of HIV. Such objectives require regimens to prevent mother-to-child transmission
(pMTCT) which, while being highly efficacious, protect the efficacy of future first-line antiretroviral therapy (ART). Major
obstacles to eliminating vertical transmissions globally include low rates of adherence to ART and non-completion of the ‘pMTCT
cascade’ due to programmatic and structural challenges faced by healthcare systems in low-income countries. Providing all
pregnant women with lifelong ART regardless of CD4 count/disease stage (Option B+) could be the most effective option to prevent
both HIV transmission and resistance, assuming adherence is successfully maintained. This strategy is more likely to achieve
sustained undetectable HIV viremia, does not involve ART interruptions, is simpler to implement, and is cost-effective. Where
Option B+ is not available, options A (short course zidovudine with single-dose nevirapine and an ARV “tail”) and B (combination
ART during pregnancy and breastfeeding, with ART cessation after weaning in women not qualifying for ART for their own health)
are also efficacious, highly cost-effective and associated with infrequent resistance selection if taken properly.

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