Prevention of Mother-to-Child HIV Transmission in Low-income Settings: Current Situation and Future Challenges

Abstract

In the developing countries an estimated 2.5 million children under the age of 15 were living with HIV in 2009 and there were some 370 000 new HIV paediatric infections. Nearly all of these new infections could have been avoided with effective prevention of mother-to-child transmission (PMTCT) interventions. Any intervention dispensed with mother-to-child transmission (MTCT) rates range from 15-30% without breastfeeding to 30-45% with prolonged breastfeeding. In developing countries where elective caesarean section and breastfeeding avoidance are generally unsafe or unaccepted options antiretroviral drugs (ARVs) have been documented to reduce MTCT to 2% or below. Even though substantial achievements were recently reported in PMTCT in implementing Sub-Saharan Africa high-burden countries much more has quickly to be done to virtually eliminate MTCT of HIV by 2015. To this aim plenty of commitment and coordinated action by all involved parties including the private sector are needed. The challenges and critical points bound-up with the desired PMTCT outcomes are discussed in this review in the light of 2010 revised WHO recommendations for PMTCT in low-income HIV settings. They recommend HIV-infected pregnant women to start ARV therapy for their own health at CD4 cell count < 350/mm 3. Additionally they promote the use of ARVs for prophylaxis earlier in pregnancy beginning at 14 weeks and continuing through the end of breastfeeding period. Moreover in countries where breastfeeding is judged to be the best option HIV-infected mothers (whose infants are uninfected or unknown status) are recommended to continue breastfeeding for the first 12 months of life provided they are taking ARVs during that period.