Antiretroviral Treatments to Reduce Mother-to-Child Transmission of HIV

Abstract

HIV Clinical Trials 2001;2(1):46–55 Agrowing number of studies demonstrate the efficacy of various perinatal antiretroviral regimens for preventing transmission of HIV from mothers to babies. This review summarizes the results available as of July 2000 (Table 1). Taken together, these studies show that the rate of transmission to the infant, which in untreated HIV-infected pregnant women exceeds 20%, can be dramatically reduced by antiretroviral therapy given in the perinatal period. Optimal regimens have been found to include treatment of the mother in the third trimester of pregnancy and during labor, with subsequent treatment of the infant for at least the first few days of life. Regimens begun at the time of labor are effective (although somewhat less so) only if followed by treatment of the infant, probably for several weeks. When prenatal care is lacking, treatment of the infant alone, especially if done within the first 48 hours of life, also provides a reduction in transmission risk. The benefit of perinatal treatment is diminished in breastfed infants compared with those who are not breastfed; perinatal treatment in the setting of breastfeeding may serve largely to shift part of the risk of infection from the peripartum period to several months later. This situation is complicated by the lack of viable alternatives to breastfeeding in many areas of the world most heavily affected by HIV. The risk of maternal-fetal transmission decreases with decreasing viral load and is very low in women receiving effective antiretroviral therapy as a matter of routine care.1,2 The risk of transmission may reach less than 1% in women with plasma Antiretroviral Treatments to Reduce Mother-toChild Transmission of HIV