Prevention of mother-to-child transmission of HIV infection

Abstract

This review aims to evaluate the prevention strategies of perinatal HIV infections and their efficacy worldwide, both in resource-limited and in resource-rich regions. Furthermore, it presents the most recent aspects of obstetric management of HIV-infected mothers. The introduction of combined antiretroviral therapy (ART) has decreased mother-to-child HIV transmission in high-income settings to historically low levels. Efforts to implement antiretroviral agents in resource-limited countries were also successful in reducing perinatal transmission. However, there are differences in prevention strategies between low and high-resource settings regarding the mode of delivery and infant feeding advice. The three-part prevention strategy (antepartum, intrapartum, and infant prophylaxis) is the most effective approach. Viral load suppression by antiretroviral treatment up to the time of birth is the most effective way to reduce perinatal transmission. Viral load and not HIV status should be used to determine the mode of delivery. Furthermore, the duration of prolonged rupture of membranes is not associated with an increased risk of HIV transmission in women with low viral load. Breastfeeding is contraindicated for mothers living with HIV in resource-rich settings, whereas in low-income areas breastfeeding remains the main nutritional source for infants. ART should be initiated as early as possible in newly diagnosed pregnant women and should be continued for life. Preventive strategies of perinatal HIV transmission have become extraordinarily successful, especially due to the introduction of antiretroviral therapy. Key strategies in the prevention of mother- to-child transmission are prompt identification and treatment of HIV-infected mothers and postpartum infant prophylaxis.