HIV-1 Infection in Pregnancy: Prevention of Mother-to-child Transmission

Abstract

There are over 22 million people worldwide infected by the HIV virus. Most HIV infections are sexually acquired, and women, mainly in the reproductive age, account for a large proportion of cases. The HIV-1 virus can be vertically transmitted during pregnancy, delivery or through breast feeding. Perinatal transmission is the main cause of paediatric HIV infections. The aim of the present review is to discuss the prevention of vertical transmission of the HIV virus from the mother to her child.The strength of evidence supports the administration of antenatal, intrapartum and neonatal zidovudine or other antiretroviral drugs. High maternal HIV load during pregnancy was found to be associated with an increased risk of vertical transmission. Zidovudine was shown to reduce the risk of vertical HIV transmission by 68 percent in a double-blind placebo-controlled randomized trial (P < 0.001). Caesareon section increases the risk of maternal complications, with a possible, albeit unproved benefit of reducing vertical transmission, and should be discussed with the mother. Other alternative methods (condom use, smoking cessation, vaginal cleansing at delivery) are more readily available worldwide. They have a positive influence on maternal health, but their role in decreasing the risk of vertical transmission awaits confirmation. Education, the use of antiretroviral therapies and safe infant bottle feeding should be made accessible to HIV-infected women whenever possible.