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: 4.68). 08/2009; 4(4):319-24. DOI: 10.1097/COH.0b013e32832a9a17
Source: PubMed


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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    • "In approximately 30% of cases, transmission occurs after the desquamation of the placenta, when the baby is passing through the birth canal12). There is a 40% risk of infection when consuming contaminated breast milk13). Preventive measures according to the Pediatric AIDS Clinical Trials Group (PACTG) protocol 076 test are reported to reduce the risk of infection by 70%, lowering the risk of mother-to-child transmission to 2%5). "
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    ABSTRACT: Administration of antiretroviral drugs to mothers and infants significantly decreases mother-to-child human immunodeficiency virus (HIV) transmission; cesarean sections and discouraging breastfeeding further decreases this risk. The present study confirmed the HIV status of babies born to mothers infected with HIV and describes the characteristics of babies and mothers who received preventive treatment. This study retrospectively analyzed medical records of nine infants and their mothers positive for HIV who gave birth at Korea University Ansan Hospital, between June 1, 2003, and May 31, 2013. Maternal parameters, including HIV diagnosis date, CD4+ count, and HIV ribonucleic acid (RNA) copy number, were analyzed. Infant growth and development, HIV RNA copy number, and HIV antigen/antibody test results were analyzed. Eight HIV-positive mothers delivered nine babies; all the infants received antiretroviral therapy. Three (37.5%) and five mothers (62.5%) were administered single- and multidrug therapy, respectively. Intravenous zidovudine was administered to four infants (50%) at birth. Breastfeeding was discouraged for all the infants. All the infants were negative for HIV, although two were lost to follow-up. Third trimester maternal viral copy numbers were less than 1,000 copies/mL with a median CD4+ count of 325/µL (92-729/µL). Among the nine infants, two were preterm (22.2%) and three had low birth weights (33.3%). This study concludes that prophylactic antiretroviral therapy, scheduled cesarean section, and prohibition of breastfeeding considerably decrease mother-to-child HIV transmission. Because the number of infants infected via mother-to-child transmission may be increasing, studies in additional regions using more variables are necessary.
    Full-text · Article · Mar 2014 · Korean Journal of Pediatrics
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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.
    Full-text · Article · Jun 2012
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    • "HIVe children had worse nutrition compared to those who were HIVn. Reasons for poorer nutrition may include parental illness and poverty [18,19], infant feeding practices [14,18], lack of breast feeding, and an increase disease burden in exposed children [6,13,14,19]. Although breast feeding rates were not recorded, it is likely that there would have been a low breast feeding rates in keeping with the PMTCT policy, which was formula feeding of children born to HIV-infected mothers in the Western Cape Province at the time of the study. "
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    ABSTRACT: HIV-exposed uninfected (HIVe) children are a rapidly growing population that may be at an increased risk of illness compared to HIV-unexposed children (HIVn). The aim of this study was to investigate the morbidity and mortality of HIVe compared to both HIVn and HIV-infected (HIVi) children after a general surgical procedure. A prospective study of children less than 60 months of age undergoing general surgery at a paediatric referral hospital from July 2004 to July 2008 inclusive. Children underwent age-definitive HIV testing and were followed up post operatively for the development of complications, length of stay and mortality. Three hundred and eighty children were enrolled; 4 died and 11 were lost to follow up prior to HIV testing, thus 365 children were included. Of these, 38(10.4%) were HIVe, 245(67.1%) were HIVn and 82(22.5%) were HIVi children.The overall mortality was low, with 2(5.2%) deaths in the HIVe group, 0 in the HIVn group and 6(7.3%) in the HIVi group (p = 0.0003). HIVe had a longer stay than HIVn children (3 (2-7) vs. 2 (1-4) days p = 0.02). There was no significant difference in length of stay between the HIVe and HIVi groups. HIVe children had a higher rate of complications compared to HIVn children, (9 (23.7%) vs. 14(5.7%) (RR 3.8(2.1-7) p < 0.0001) but a similar rate of complications compared to HIVi children 34 (41.5%) (RR = 0.6 (0.3-1.1) p = 0.06). HIVe children have a higher risk of developing complications and mortality after surgery compared to HIVn children. However, the risk of complications is lower than that of HIVi children.
    Full-text · Article · Jul 2011 · BMC Pediatrics
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