Advances in the Prevention of Perinatal HIV-1 Transmission

Abstract

After completing this article, readers should be able to: 1. Describe the impact of antiretroviral prophylactic regimens on mother-to-child transmission of HIV-1. 2. Delineate United States Public Health Service Task Force guidelines for preventing perinatal transmission of HIV-1. 3. Describe efforts being taken to prevent the transmission of HIV-1 in human milk. Significant advances have occurred in the prevention of perinatal transmission of human immunodeficiency virus type 1 (HIV-1) during the last decade in the United States and Europe. (1) In 1994, the Pediatric AIDS Clinical Trials Group (PACTG) 076 published data showing that a long course of zidovudine (ZDV) prophylaxis given to HIV-1 infected mothers during the antepartum and intrapartum periods and postnatally to the baby significantly reduced perinatal HIV-1 transmission. (2) Since then, rates of perinatal HIV-1 transmission have decreased to less than 2% in resource-rich countries due to widespread implementation of universal prenatal HIV-1 testing, antiretroviral prophylaxis, elective cesarean section, and avoidance of breastfeeding. (1)(3) Currently, fewer than 400 infants acquire HIV-1 from their mothers in the United States. (1)(3) In contrast, prevention of perinatal transmission of HIV-1 is a major public health challenge in many resource-limited countries. (4) Each day, more than 2,000 infants are born infected with HIV-1 globally, and by the end of 2002, approximately 3.2 million children were living with HIV-1. (5) More than 90% of affected children reside in resource-limited countries. (1) Although many effective, simple, and less expensive antiretroviral prophylaxis regimens are available to prevent mother-to-child HIV-1 transmission, these interventions have not been implemented on a large scale in resource-limited settings. (1) This article reviews advances in the prevention of perinatal HIV-1 transmission, highlights progress made in resource-rich countries, and discusses challenges faced by resource-limited countries. Mother-to-child transmission (MTCT) of HIV-1 can take place in utero, during labor and …