Reduction Of Vertical Transmission Research Articles

Cost-effectiveness of intervention combinations towards the elimination of vertical transmission of HIV in limited-resource settings: a mathematical modelling study

Since 2000, there has been a substantial global reduction in the vertical transmission of HIV. Despite effective interventions, gaps still remain in progress towards elimination in many low-income and middle-income countries. We developed a mathematical model to determine the most cost-effective combinations of interventions to prevent vertical transmission. We developed a 12-month Markov model to follow a cohort of women of childbearing age (aged 15-49 years) in Zambia (n=1 107 255) who were either pregnant, in delivery, or breastfeeding; the population included in the model reflects the estimated number of pregnant women in Zambia from the 2018 Zambia Demographic and Health Survey. The model incorporated nine interventions: infant prophylaxis; three different HIV retesting schedule options; oral pre-exposure prophylaxis; maternal peer-support groups; regimen shift; tracing of loss to follow-up; and point-of-care viral load testing. We analysed incident HIV infections among mothers and infants, intervention costs, and evaluated 190 scenarios of different combinations of inventions to calculate the incremental cost-effectiveness ratios (ICERs) over 1 year. Three interventions with the greatest reduction in vertical transmission, individually, were support groups for 80% of those in need (35% reduction in infant infections), HIV retesting schedules (6·5% reduction), and infant prophylaxis (4·5% reduction). Of all 190 scenarios evaluated, eight were on the cost-effectiveness frontier (ie, were considered to be cost-effective); all eight included increasing infant prophylaxis, regimen shift, and use of support groups. Excluding the highest-cost scenarios, for a 1-22% increase in total budget, 23-43% of infant infections could be prevented, producing ICERs between US$244 and $16 242. Using the interventions modelled, it is possible to reduce vertical transmission and to cost-effectively prevent up to 1734 infant HIV infections (43% reduction) in Zambia over a period of 1 year. To optimise their effect, these interventions must be scaled with fidelity. Future work is needed to incorporate evidence on additional innovative interventions and HIV risk factors, and to apply the model to other country contexts to support targeted implementation and resource use. The ELMA Foundation.

Qualitative analysis of HIV and AIDS disease transmission: impact of awareness, testing and effective follow up.

Background: Since the early 1980s, human immunodeficiency virus (HIV) and its accompanying acquired immunodeficiency syndrome (AIDS) have spread worldwide, becoming one of the world's major global health issues. From the beginning of the epidemic until 2020, about 79.3 million people became infected, with 36.3 million deaths due to AIDS illnesses.This huge figure is a result of those unaware of their status due to stigmatization and invariably spreading the virus unknowingly. Methods: Qualitative analysis through a mathematical model that will address HIV unaware individuals and the effect of an increasing defaulter on the dynamics of HIV/AIDS was investigated. The impact of treatment and the effect of inefficient follow-up on the transmission of HIV/AIDS were examined. The threshold for the effective reduction of the unaware status of HIV through testing, in response to awareness, and the significance of effective non-defaulting in treatment commonly called defaulters loss to follow-up as these individuals contribute immensely to the spread of the virus due to their increase in CD4+ count was determined in this study. Stability analysis of equilibrium points is performed using the basic reproduction number $R_0$, an epidemiological threshold that determines disease eradication or persistence in viral populations.We tested the most sensitive parameters in the basic reproduction numbers. Results: The results portray that early identification and treatment only are inadequate for the illness to be eradicated, but effectively used of condom, strict adherence to treatment and counseling of and testing of pregnant women contribute to a decrease in infected HIV individuals. Conclusions: Other control techniques, such as treatment adherence and effective condom usage, and reduction in vertical transmission cannot be over-emphasis to lessen the disease's burden. Policymakers must address these strategies through a series of public awareness campaigns about the dangers of not adhering to treatment procedures and patterns.

Immunization with a Multivalent Listeria monocytogenes Vaccine Leads to a Strong Reduction in Vertical Transmission and Cerebral Parasite Burden in Pregnant and Non-Pregnant Mice Infected with Neospora caninum.

Neospora caninum is an apicomplexan parasite that causes abortion and stillbirth in cattle. We employed the pregnant neosporosis mouse model to investigate the efficacy of a modified version of the attenuated Listeria monocytogenes vaccine vector Lm3Dx_NcSAG1, which expresses the major N. caninum surface antigen SAG1. Multivalent vaccines were generated by the insertion of gra7 and/or rop2 genes into Lm3Dx_NcSAG1, resulting in the double mutants, Lm3Dx_NcSAG1_NcGRA7 and Lm3Dx_NcSAG1_NcROP2, and the triple mutant, Lm3Dx_NcSAG1_NcGRA7_NcROP2. Six experimental groups of female BALB/c mice were inoculated intramuscularly three times at two-week intervals with 1 × 107 CFU of the respective vaccine strains. Seven days post-mating, mice were challenged by the subcutaneous injection of 1 × 105N. caninum NcSpain-7 tachyzoites. Non-pregnant mice, dams and their offspring were observed daily until day 25 post-partum. Immunization with Lm3Dx_NcSAG1 and Lm3Dx_NcSAG1_NcGRA7_NcROP2 resulted in 70% postnatal pup survival, whereas only 50% and 58% of pups survived in the double mutant-vaccinated groups. Almost all pups had died at the end of the experiment in the infection control. The triple mutant was the most promising vaccine candidate, providing the highest rate of protection against vertical transmission (65%) and CNS infection. Overall, integrating multiple antigens into Lm3Dx_SAG1 resulted in lower vertical transmission and enhanced protection against cerebral infection in dams and in non-pregnant mice.

Prevention strategies for congenital cytomegalovirus infection.

Cytomegalovirus (CMV) is the most common viral cause of congenital infection, occurring in approximately 1-2% of live births worldwide. Given our increasing knowledge of risk, advances in the identification of maternal infection, and the extremely limited options for the treatment of fetal infection, the prevention is a promising direction for research efforts. Recently, there have been several exciting studies assessing different ways of preventing congenital infection in the fetus and one in particular has focused on the use of valaciclovir. A recent study reported a 71% reduction in vertical transmission of CMV with the use of oral valaciclovir following maternal primary CMV infection early in pregnancy. The clinical impact of this study could be enormous and it has particular implications for considerations around maternal serological screening in the first trimester of pregnancy. Further research assessing behaviour modifications during early pregnancy could also provide evidence for an effective primary prevention technique. Prevention of congenital CMV infection, whether primary, secondary or tertiary, is possible, however, there are barriers to its utilisation in a clinical setting. The main limitation is the requirement for early, effective and large-scale serological screening of mothers to detect asymptomatic primary infection.

Assistência de enfermagem às gestantes diagnosticadas com HIV no pré-natal: Uma revisão integrativa

O objetivo desse estudo foi saber como é prestada a assistência de enfermagem às gestantes diagnosticadas com HIV no pré-natal e identificar as ações de enfermagem desenvolvidas às gestantes diagnosticadas com HIV durante o pré-natal e suas contribuições. Trata-se de um estudo de  revisão integrativa da literatura, com abordagem quantitativa, com busca realizada entre os meses de fevereiro a março de 2021 nas bases de dados da Scientific Eletronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Banco de Dados em Enfermagem  e Medical Literature Analysis and Retrieval System Online utilizando-se os Descritores em Ciências da saúde: Gestante HIV, Assistência de enfermagem e Cuidado Pré-Natal, por meio do acrômio PICo. No início foram resgatados 535 estudos, no entanto após aplicabilidade dos critérios de inclusão (pesquisas originais que respondiam a pergunta da pesquisa e publicadas nos idiomas português, inglês e espanhol) e exclusão (estudos duplicados, teses, dissertações, monografias, manuais, editorial, estudos de revisão), obteve-se 21 estudos, após leitura dos títulos e resumos, restaram 15 estudos para análise, síntese e discussão. Percebe-se a importância do início da assistência no planejamento e não apenas no pré-natal, sendo esse um momento oportuno para investigação da história clínica do casal, possíveis situações de risco e vulnerabilidade no sentido de planejar uma gravidez segura para a mãe e feto. Além disso, observa-se que a assistência integral, holística e humanizada as gestantes diagnosticadas com HIV no pré-natal, tem contribuído na redução da transmissão vertical da doença.

Perfil clí­nico e epidemiológico de gestantes com HIV positivo atendidas em um hospital municipal de Niterói

Objetivo: Avaliar o perfil epidemiológico das gestantes HIV positivo, acompanhadas no Ambulatório do Hospital Municipal Carlos Tortelly de Niterói – RJ. Metodologia: Trata-se de um estudo epidemiológico retrospectivo, quantitativo e descritivo. Consta de 103 gestantes HIV positivo na faixa etária 18 e 45 anos, atendidas no ambulatório de SIDA/Hospital Municipal Carlos Tortelly (HMCT), durante o perí­odo de dezembro de 2009 a dezembro de 2015. Resultados: A faixa etária predominante entre 21 a 30 anos (57,3%), sendo que 40,8% tinham ensino fundamental, 30,1% com renda familiar em torno de um salário mí­nimo, e a maioria 60,2% procedia no Municí­pio de Niterói. A detecção do HIV, majoritariamente, ocorreu antes da gravidez (57,3%), e apenas 14,6% das gestantes não consumia alguma substância quí­mica durante a gestação e 45,6% não sofreram infecção oportunista durante o acompanhamento, 28,2% já tinham dois ou mais filhos. Cesária não eletiva foi a maior forma de escolha para o nascimento (53,4%). Conclusão: O perfil se caracteriza por situação socioeconômica vulnerável, com baixo ní­vel de escolaridade, e o diagnóstico anterior precedem a gestação atual. A realização do pré-natal, e a terapia TARV na gestação e no parto foi alto. Para tanto, faz-se necessário o melhoramento das informações e ações direcionadas í  ampliação da atenção í s mulheres, cuja garantia integral e o diagnóstico precoce do HIV constituem artifí­cios importantes na redução da transmissão vertical.

[Relationship between the supply of syphilis diagnosis and treatment in primary care and incidence of gestational and congenital syphilis].

Brazil has reported an increase in the incidence of both gestational and congenital syphilis, posing a serious public health problem in the country. The study aimed to analyze the relationship between the supply of syphilis diagnosis and treatment in primary care and the incidence rates of gestational and congenital syphilis. An ecological study analyzed these incidence rates and the coverage of diagnostic and therapeutic measures in primary care. The study sample consisted of municipalities (counties) with population over 20,000, with coverage by primary care over 50%, and where the majority of the teams were assessed in the second cycle of the National Program for Improvement of Access and Quality of Basic Care. Analysis of the effectiveness of detection and treatment measures was based on the development of the Index of Variation in Vertical Syphilis Transmission. The administration of penicillin and application of the rapid test in these municipalities showed median rates of 41.9% and 67.14%, respectively, with regional differences. Median incidence of gestational syphilis was 6.24 (IQR: 2.63-10.99) in municipalities with a higher supply of the rapid test and 3.82 (IQR: 0.00-8.21) in those with a lower supply, indicating an increase in detection capacity. Municipalities with a reduction in vertical transmission showed higher median rates of teams with supply of rapid testing and (83.33%; IQR: 50.00-100.00) and administration of penicillin (50.00%; IQR: 11.10-87.50), demonstrating a relationship between these measures and the reduction in congenital syphilis. The findings indicate the need to expand these services and to reinforce the importance of reducing vertical transmission.

Applying Quality Improvement Approaches to Reduce Mother-to-Child HIV Transmission and Improve Health and Nutrition Care in Five Countries: Lessons from the Partnership for HIV-Free Survival.

The World Health Organization guidelines for treating pregnant HIV-positive women and preventing HIV transmission to infants now recommend lifelong antiretroviral treatment for pregnant and breastfeeding women. We applied quality improvement (QI) methods to support governments and facility staff to address service gaps in 5 countries under the Partnership for HIV-Free Survival (PHFS). We used 3 key strategies: break the complex problem of improving HIV-free survival into more easily implementable phases, support a national management team to oversee the project, and support facility-level staff to learn and apply QI methods to reducing mother-to-child transmission. The key results in each country were increases in data completeness and accuracy, increases in retention in care of mother–baby pairs (MBPs), increase in coverage of MBPs with appropriate services, and reduction in vertical transmission of HIV. The PHFS experience offers a model that other multicountry networks can adopt to improve service delivery and quality of care.

Antiretroviral initiation of pregnant women and antenatal care booking practices in eThekwini District, KwaZulu-Natal, South Africa.

BackgroundThe introduction of antiretroviral therapy (ART) in South Africa began as part of the prevention of mother-to-child transmission programme. For significant reduction of vertical transmission, early antenatal care booking and ART initiation are necessary.AimThis study aimed to evaluate ART initiation and booking practices of women attending antenatal care in eThekwini district during financial years (FY) 2010/2011 and 2013/2014.MethodsAn observational study used a retrospective chart review at four eThekwini district community health centres (CHC). From these CHCs, records of women that initiated ART in FY10/11 and FY13/14 were reviewed and compared for ART initiation delays and booking practices.ResultsA total of 2749 pregnant women who attended antenatal care (ANC) at the study sites were found eligible for ART; of these, 49% (n = 1334) attended ANC in FY10/11 while 51% (n = 1414) attended in FY13/14. In FY10/11, 46% (n = 610) and 60 % (n = 855) of the women were initiated on ART during pregnancy. The mean gestational age at booking for FY10/11 was 20.88 (standard deviation [s.d.] = 5.6) and 18.40 (s.d. = 6.2) in FY13/14. The mean gestational age at ART initiation for women who initiated ART in FY10/11 was 26.30 (s.d. = 6.02) and in FY13/14 it was 19.06 (s.d. = 6.86).ConclusionIn FY13/14 ART initiations occurred within 4 days after booking. ANC booking before 20 weeks was found to have improved between the two years from 39% to 58%; however, on average, in both years women booked during the second trimester.

Assessment of the prevalence of vertical hepatitis B transmission in two consecutive generations.

Hepatitis B is an important public health problem in the world and one of the forms of contagion would be through vertical transmission. Precose diagnosis allows the adoption of prophylaxis measures, which results in prevention in more than 90% of cases. To describe the prevalences of vertical transmission and compare two generations (mother/patient and patient/child). This was a cross-sectional study, which included 101 patients. The interviews were performed through the application of the instrument of data collection and information of the physical file before the medical consultation. The mean ± SD of age was 50.9 ± 13.1 years, the male gender predominated, with 56.4% of the patients, and the predominance was white, with 43.6%. Vertical transmission between mother and patient occurred in 17.8% and between patient and child, in 7.9%. In all of the eight cases of vertical transmission, the diagnosis was after the birth of children infected with HBV, and in 3/8 (37.5%), there was more than one case of infection by this mechanism per patient, totaling 13 children with the disease. There was a reduction in vertical transmission, showing that preventive measures were effective.

Vertical Transmission of HIV-1 in the Metropolitan Area of Belo Horizonte, Brazil: 2006-2014.

To revise HIV-1 vertical transmission (VT) rates in the metropolitan area of Belo Horizonte, Brazil, from January of 2006 to December of 2014. Descriptive study of a prospective cohort of HIV-1-infected pregnant women and their children, monitored by the Maternal and Child HIV/Aids Research Group of Research Group at Faculty of Medicine of Universidade Federal de Minas Gerais, Brazil. The VT general rate was 1.9% (13/673; confidence interval [CI] 95%: 1.0-3.3). The extensive use of combined highly active antiretroviral therapy (HAART) (89.7%; 583/650) strongly impacted the reduction of VT during this period. Maternal viral load (VL) higher than 1,000 copies/mL showed significant association with VT (OR:6.6; CI 95%:1.3-33.3). Maternal breastfeeding was described in 10 cases in this cohort (1.5%; CI 95%: 0.7-2.7), but it was not associated with VT. The present cohort data were coherent with the low VT rate described in other global populations, and it was considerably lower in comparison to the results of the same cohort during the period of 1998-2005, when the VT rate was 6.2%. These data confirm the efficiency of the National Guidelines, and emphasize the importance of adopting the international recommended procedures for prevention of mother-to-child transmission (MTCT) of HIV.

Update on treatment of cytomegalovirus infection in pregnancy and of the newborn with congenital cytomegalovirus.

The purpose of this review is to assess the recent studies of therapy of pregnant women and neonates, aimed at preventing the consequences of congenital cytomegalovirus (CMV) infection. A recent randomized controlled trial of treatment of CMV during pregnancy with hyperimmune globulin did not show significant efficacy in prevention of foetal infection and morbidity, although there was a trend towards improvement with treatment. Trials of antiviral therapy of the mother during pregnancy have involved small numbers only, confounded by ethical and practical difficulties, and further studies are needed to demonstrate whether or not antivirals are useful and well tolerated in this setting.Antiviral treatment of neonatal CMV acquired congenitally has been studied in well controlled trials and the antiviral valganciclovir has shown efficacy in reducing the more severe outcomes. Trials are ongoing of the use of antivirals in less severe disease, although results are likely to take several years. Congenital CMV infection is the most frequent cause of congenital malformation in developed countries, with a symptomatic prevalence of 0.64% of all live births. Infection may result in neurodevelopmental delay, foetal or neonatal death, and most frequently, sensorineural hearing loss. Successful control of viral infections during pregnancy and in the newborn period is essential in reducing early and late morbidity and mortality. Control of congenital CMV infection may be via primary prevention methods such as reducing contact with the pathogen, improved hygiene - both for the pregnant mother and for the neonate, or secondary prevention via reduction of vertical transmission from mother to foetus and reduction in consequences of infection by treatment of infected pregnant women and infected neonates.

Prevention of mother-to-child transmission in South Africa: an ever-changing landscape.

Almost 30% of pregnant women attending public health clinics in South Africa are HIV positive; which represents approximately 280,000 women each year. South Africa has the largest antiretroviral therapy programme in the world, with over 2.7 million people on treatment in 2013. Since its belated and controversial beginning, the Prevention of Mother-to-Child Transmission programme has achieved a substantial reduction in vertical transmission. South Africa is justifiably proud of this success. However, the history of Prevention of Mother-to-Child Transmission (PMTCT) and antiretroviral therapy programmes in South Africa has been fraught with delays and political intervention. South Africa could have started both PMTCT and antiretroviral therapy programmes in 2000. Instead, the AIDS denialist views of the government allowed the HIV epidemic to spiral out of control. Roll-out of a national PMTCT programme began in 2002, but only after the government was forced to do so by a Constitutional Court ruling. Now, a decade later, HIV treatment and prevention programmes have been completely transformed. This article will discuss the evolution of the HIV epidemic in South Africa, and give a historical overview of the struggle to establish a national PMTCT, and the impact of delaying PMTCT and treatment programmes on infant and maternal health.

[HIV and pregnancy].

The use and success of antiretroviral treatment in HIV-positive people has led to a reduction of vertical transmission of HIV. Pregnancy in HIV-positive women became more common. The success of prophylactic measures has led to a dramatic change in care of HIV-positive women. Today, a HIV-positive mother giving birth to a HIV-negative child is standard of care in industrialized countries. We describe the impact of an HIV-infection in pregnancy and outline the most important diagnostic and therapeutic aspects.

Caesarean section to prevent transmission of hepatitis B: a meta-analysis.

Vertical transmission of hepatitis B virus (HBV) occurs in up to 10% to 20% of births. To assess whether Caesarean section, compared with vaginal delivery, prevents HBV transmission. A systematic review and meta-analysis was conducted. Two investigators independently searched PubMed, EMBASE and other databases for relevant studies published between 1988 and 2013. A manual search of relevant topics and major conferences for abstracts was also conducted. Randomized trials, cohort and case-control studies assessing the effect of delivery mode on vertical transmission of HBV were included. Studies assessing antiviral therapy and patients with coinfection were excluded. The primary outcome was HBV transmission rates according to delivery method. Of the 430 studies identified, 10 were included. Caesarean section decreased the odds of HBV transmission by 38% compared with vaginal delivery (OR 0.62 [95% CI 0.40 to 0.98]; P=0.04) based on a random-effects model. Significant heterogeneity among studies was found (I²=63%; P=0.003), which was largely explained by variation in hepatitis B immune globulin (HBIG) administration. Meta-regression showed a significant linear association between the percentage of infants receiving HBIG per study and the log OR (P=0.005), with the least benefit observed in studies with 100% HBIG administration. Subgroup analysis of hepatitis B e-antigen-positive women who underwent Caesarean section did not show a significant reduction in vertical transmission. Caesarean section may protect against HBV transmission; however, convincing benefit could not be demonstrated due to significant study heterogeneity from variable HBIG administration, highlighting the importance of HBIG in HBV prevention. More high-quality studies are needed before any recommendations can be made.

P6.025 The Brazilian Experience in the Joint Construction of Action Plans For the Prevention, Control, Surveillance, Diagnosis and Treatment of STDs, AIDS and Viral Hepatitis Among Indigenous Populations

BackgroundWithin the Brazilian context, it is possible to say that indigenous populations are among the groups at highest risk and vulnerability to HIV, AIDS and viral hepatitis (VH). With the...

Outcome of pregnancy in the era of highly active antiretroviral: a 10‐year experience in Southern Ireland

IntroductionSince the introduction of HAART the desire to become a mother in women with HIV has become a viable option due to the drastic reduction in vertical transmission. The aim of this study was to look at the epidemiology, clinical characteristics, and safety of antiretroviral drugs and rate of vertical transmission in our cohort in the Munster region, Ireland.MethodsWe retrospectively reviewed all pregnant women with HIV who attended the ID clinic from January 2002 to April 2012. Patients’ demographics, pertinent laboratory data, and pharmacy records were reviewed and statistically analysed.Results105 HIV‐positive women, with a total of 165 pregnancies, were seen from January 2002 to April 2012 at Cork University Hospital: 46 patients were previously known to be HIV‐infected at their first pregnancy and 59 were diagnosed during antenatal screening (median of 32 week gestation at diagnosis). The median age at the time of pregnancy was 32 and the HIV transmission was 90% sexual: 39 women were from Europe/Asia and 66 were African; only two women were HCV co‐infected and one was HBV co‐infected. Of the patients diagnosed with HIV prior to pregnancy, 13 were on treatment, all of whom had no detectable virus at the start and during pregnancy. The median CD4+ at the start of pregnancy was 490 cells/µl. The median weeks of gestation at the start of HAART was 28 before 2006 and 20 after 2006, in accordance with National Guidelines. The HAART regime used was in line with current Guidelines. 18 pregnancies ended in miscarriage before week 12 gestation and 2 pregnancies resulted in intrauterine death at 28 weeks. 145 pregnancies progressed to delivery at full term but 10 infants were born before the 37th week, with one baby born at 23 weeks: 63 had SVD and 82 underwent C‐section, of whom 12 emergency C‐section due to prolonged membrane rupture. Most of the C‐sections were planned due to obstetric reasons. 2 infants were born HIV+: in one case the mother was a late presenter at 38 of gestation; and in other the mother had poor compliance with viral load detectable at the time of labour. The overall number of pregnancies per year has been stable over the ten years (average of 14 pregnancies per year).ConclusionThe use of cART with high level of adherence and a close clinical management during pregnancy has shown to dramatically reduce the vertical transmission of HIV in our cohort.

Paediatric Antiretroviral Drug Targets

HIV-1 infection is a major problem for children in lower income countries. The benefit of early antiretroviral (ARV) therapy started within 12 weeks of life is well documented. Although the development of new drug classes give alternative options for highly treatment experienced patients there is inadequate pharmacokinetic knowledge regarding the already established ARV classes in infants and children. Also, there are many practical challenges to administering these agents to children. The challenges of current widely available treatment regimens in the light of new vertical transmission prevention guidelines are discussed. The dynamic physiological changes affecting pharmacokinetics in infancy and childhood are reviewed. New antiretroviral drugs in the established drug classes are presented. The new drug classes of entry inhibitors (including co-receptor binding inhibitors and fusion inhibitors), integrase inhibitors and other novel drug classes under development are described and relevant pediatric studies are reviewed. Work on novel drug delivery systems with potential to enhance adherence, improve drug exposure and reduce side-effects are discussed. The established benefits of ARV therapy in children of all ages can be enhanced by appropriate pharmacokinetic data on established antiretroviral agents and child-friendly drug formulations. Besides new suppressive treatment options in treatment experienced patients with multi-class resistant virus the new drug classes provide potential for novel means of disease modification and reduction of vertical transmission. Novel drug classes and delivery systems in development provide potential for further reduction in vertical transmission of HIV, rapid virological suppression and improved neurological outcomes in children and adults.

Breastfeeding In Pmtct Services; Tilting The Balance In Favour Of Cost-Effective Programme

By 2005, the world's estimated population of people living with HIV/AIDS (PLWHA) was 40.3 million. Sub-Saharan Africa (SSA) contributed 25.8 million (over 64%) and almost one million more than in 2003. Of the estimated 4.9 million people newly infected with the virus in 2005, SSA contributed 3.2million (over 65%).1 With an estimated population of 3.7million people infected with the virus,3 Nigeria has the third largest population of PLWHA, being next to India and South Africa in that order.1The implication of this is that the devastation of the disease was yet to take a downward trend. It is estimated that over 14% of all new HIV infections are in paediatric patients compared with 10% in 2003. Over 90% of these infections are from vertical transmission. World-wide, over 95% of the under-5 infected with HIV are Africans without preventive measures, about 35% of all children born to HIV-positive mothers will be infected. HIV infection is now a chronic treatable but yet incurable disease in developed countries but this is not so in SSA where the preponderance of the infection is on the increase and mortality of the infection is most severe. Preventing vertical transmission (VT) is the noble goal of Prevention of Mother-to-Child Transmission (PMTCT) Programmes. In the absence of a cure, it is a cost-effective way of reducing the HIV burden and ensuring a future HIV- free generation. The interventions are targeted at the antenatal, intrapartum and the post natal periods.4-9 Post natal interventions target optimal child feeding options and paediatric antiretroviral therapy for post exposure prophylaxis in addition to counseling on other harmful socio-cultural practices. Of all the interventions aimed at reducing VT, breastfeeding is the only one that is most influenced by culture and social belief and dichotomized by racial and socio-economic factors. Fortunately, it is also the only one that the would- be-mother can positively or negatively influence its effect on the outcome on the infant. Though, the Nigerian PMTCT programme started since 2002, no scientific figures are available for VT for breastfed and non-breastfed infants. In spite of this, mothers are often left to make the choice between breastfeeding and formula feeding of their infants in the so called informed choice. But records available from Africa and elsewhere have often revealed the deleterious effects of breast feeding in good PMTCT programmes. From our practical experience, the issue of breastfeeding is still contentious can easily cause a divide among counselors themselves and clinicians too. This review focuses on the issue of breastfeeding, the past, the present and a look into the future as it is likely to affect the PMTCT programme and its implications for the Nigeria populace. It also examined factors that may be militating against success of interventions aimed at reduction of VT in the programme. We are of the view that those women who are electing for breastfeeding may not be getting enough information on the implication of their decisions. Also, socioeconomic pressures may be the most compelling factor for their choice of infant feeding. We suggest that interventions should urgently be targeted at the militating factors for timely realization of the goal 4 in the Millennium Development Goals of Nigeria. Encouraging breastfeeding under any guise will amount to tilting the balance in favour of a less cost- effective PMTCT Programme. Keywords : Breastfeeding, PMTCT, Vertical Transmission, Cost Effective Programme. Annals of Biomedical Science Vol. 4 (1) 2005: pp. 1-9

Infección por virus de inmunodeficiencia humana en la infancia

This paper describes the increasing trends and changing patterns of human immunodeficiency virus (HIV) infection in children occurring since 1982-83 when the first cases were reported worldwide and from 1987-89 when the first cases were detected in Chile. Advances and obstacles dealing with pediatric HIV in Chile are discussed. The most relevant advance is the outstanding reduction in vertical transmission of HIV associated with the implementation of preventive strategies. Risk of vertical transmission has decreased from 35%o in absence of preventive strategies to 2%o with prevention that include maternal and newborn antiretroviral therapy, elective caesarean section and replacement of breast feeding by artificial milk. The main obstacle to further reduce cases has been the delay in implementation of universal screening for pregnant women. This delay has resulted in that currently, the great majority of pediatric HIV cases are detected among symptomatic children. We propose a guideline to detect and appropriately derive pregnant women infected with HIV and children exposed or infected with the virus in order to further reduce the number of children with AIDS in Chile.