Abstract
Recognising and managing increased HIV transmission risk in newborns
Highlights
In South Africa, prevention of mother-to-child transmission (PMTCT) programmes have been very successful in reducing the vertical transmission of HIV, with resultant gains in maternal, infant and child health and survival.[1,2]Complete elimination of mother-to-child transmission (MTCT) remains elusive, primarily because of incomplete programme uptake – owing to suboptimal patient care-seeking behaviour and inadequate health care access – and because no current antiretroviral therapy (ART) regimen, even when started early in pregnancy, is 100% effective in preventing transmission
This is accentuated by suboptimal maternal viral suppression and limited pre-labour combination ART (cART) duration
An increased risk of intra-partum HIV infection can be reduced by boosted infant post-exposure prophylaxis (PEP)
Summary
In South Africa, prevention of mother-to-child transmission (PMTCT) programmes have been very successful in reducing the vertical transmission of HIV, with resultant gains in maternal, infant and child health and survival.[1,2]Complete elimination of mother-to-child transmission (MTCT) remains elusive, primarily because of incomplete programme uptake – owing to suboptimal patient care-seeking behaviour and inadequate health care access – and because no current antiretroviral therapy (ART) regimen, even when started early in pregnancy, is 100% effective in preventing transmission. Recognition of increased-risk scenarios, enhanced labour management (including intra-partum antiretrovirals [ARVs] and caesarean section before labour), infant post-exposure combination ARV prophylaxis (cARP) and a more aggressive testing schedule may all reduce transmission risk and improve the linkage of HIV-infected infants to definitive management.
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