Proposed Guidelines for the Prevention of Mother-To-Child Transmission of HIV in Middle-Income Countries: The Thai Red Cross Pmtct Guidelines

Abstract

The rate of perinatal HIV transmission has drastically decreased in high-income countries where interventions to reduce mother-to-child transmission of HIV have been successfully implemented. Guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) from developed countries recommend high-standard interventions and monitoring to minimize transmission in individual cases as much as possible. However, WHO PMTCT guidelines aim more towards universal access and focus on settings with the highest HIV burden and most limited resources. WHO PMTCT guidelines display skepticism and only briefly mention triple-drug antiretroviral therapy (ART) for PMTCT in situations where resources may be available. Middle-income countries with adequate health system infrastructure and willingness to provide PMTCT services that are more advanced than that of low-income countries require different PMTCT guidelines. Triple-drug ART should be offered to all pregnant women. Nevirapine-based ART may be used safely in subgroups of pregnant women with CD4 counts less than 250–350 cells/mm3, when the monitoring of pregnant women with frequent clinic visits and low-cost laboratory tests are feasible.