Current HIV/AIDS Reports

, Volume 3, Issue 2, pp 59–65 | Cite as

Update: Preventing mother-to-child transmission of HIV

Article

Abstract

The success of antiretroviral therapies for prevention of mother-to-child transmission of HIV in the developed world has prompted a wide array of research efforts, from improved implementation of voluntary counseling and testing programs to innovative approaches for short-course peripartum prophylaxis to understanding the dynamics of HIV transmission via breastfeeding. Clinical trials of modified short-course peripartum regimens which are applicable to resource-limited areas are demonstrating much lower transmission rates and preliminary data are emerging on limiting transmission via breastfeeding. Some of the most recent data on these topics are reviewed. Primary prevention of HIV in women of childbearing age combined with efforts to prevent mother-to-child transmission of HIV offer the best hope for addressing the burden of HIV in women and children.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization: AIDS Epidemic Update: December 2005. http://www.unaids. org/epi/2005/doc/EPIupdate2005_html_en/epi05_00_ en.htm. Accessed January 6, 2006.Google Scholar
  2. 2.
    Sweat MD, O‘Reilly K, Schmid GP, et al.: Cost-effectiveness of nevirapine to prevent mother-to-child transmission in eight African countries. AIDS 2004, 18:1661–1671.PubMedCrossRefGoogle Scholar
  3. 3.
    Malonza IM, Richardson BA, Kreiss JK, et al.: The effect of rapid HIV-1 testing on uptake of perinatal HIV-1 interventions: a randomized clinical trial. AIDS 2003, 17:113–118.PubMedCrossRefGoogle Scholar
  4. 4.
    Welty TK, Bulterys M, Welty ER, et al.: Integrating prevention of mother-to-child HIV transmission into routine antenatal care: the key to program expansion in Cameroon. J Acquir Immune Defic Syndr 2005, 40:486–493.PubMedCrossRefGoogle Scholar
  5. 5.
    Manzi M, Zachariah R, Teck R, et al.: High acceptability of voluntary counseling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting. Trop Med Int Health 2005, 10:1242–1250.PubMedCrossRefGoogle Scholar
  6. 6.
    Fawzi WW: Acceptance of HIV testing among pregnant women in Dar-es-Salaam, Tanzania. J Acquir Immune Defic Syndr 2004, 37:1197–1205.PubMedCrossRefGoogle Scholar
  7. 7.
    American College of Obstetricians and Gynecologists: ACOG Committee opinion 304, November 2004. Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol 2004, 104:1119–1124.Google Scholar
  8. 8.
    Bulterys M, Jamieson DJ, O‘Sullivan MJ, et al.: Rapid HIV testing during labor — a multicenter study. JAMA 2004, 292:219–223.PubMedCrossRefGoogle Scholar
  9. 9.
    Dunkle KL, Jewkes RK, Brown HC, et al.: Gender-based violence, relationship power and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet 2004, 363:1415–1421.PubMedCrossRefGoogle Scholar
  10. 10.
    Luscher-Mattli M: Polyanions — a lost chance in the fight against HIV and other virus diseases? Antivir Chem Chemother 2000, 11:249–259.PubMedGoogle Scholar
  11. 11.
    Callahan M: Chemical and physical barriers to HIV infection. Female initiated methods of HIV prevention, The Bill and Melinda Gates Foundation Satellite Symposium. Paper presented at the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment. Rio de Janeiro, Brazil; July 24–27, 2005.Google Scholar
  12. 12.
    Jiang S, Liu S, Lu H, Neurath AR: Synergistic and complementary effects of the anti-HIV-1 microbicides CAP and UC781 in combination [abstract MoPp0103]. Paper presented at the 3rd International AIDS Society Conference on Pathogenesis and Treatment. Rio de Janeiro, Brazil; July 24–27, 2005.Google Scholar
  13. 13.
    Harman S, Perumal D, Fletcher P, et al.: TMC120 blocks HIV-1 infection in cellular and human cervical tissue models [abstract MoPp0105]. Paper presented at the 3rd International AIDS Society Conference on Pathogenesis and Treatment. Rio de Janeiro, Brazil; July 24–27, 2005.Google Scholar
  14. 14.
    Lederman MM, Veazey RS, Offord R, et al.: Prevention of vaginal SHIV transmission in rhesus macaques through inhibition of CCR5. Science 2004, 306:485–487.PubMedCrossRefGoogle Scholar
  15. 15.
    Moore JP: Topical microbicides become topical. New Engl J Med 2005, 352:298–300.PubMedCrossRefGoogle Scholar
  16. 16.
    Veazey RS, Klasse PJ, Schader SM: Protection of macaques from vaginal SHIV challenge by vaginally delivered inhibitors of virus-cell fusion. Nature 2005, 438:99–102.PubMedCrossRefGoogle Scholar
  17. 17.
    Allen S: International data. J Acquir Immune Defic Syndr 2005, 38(Suppl 1):S7–8.PubMedGoogle Scholar
  18. 18.
    Kiddugavu M, Makumbi F, Wawer MJ, et al.: Hormonal contraceptive use and HIV-1 infection in a population based cohort in Rakai, Uganda. AIDS 2003, 17:233–240.PubMedCrossRefGoogle Scholar
  19. 19.
    Sauer MV, Chang PL: Establishing a clinical program for human immunodeficiency virus 1-seropositive men to father seronegative children by means of in vitro fertilization with intracytoplasmic sperm injection. Am J Obstet Gynecol 2002, 186:627–633.PubMedCrossRefGoogle Scholar
  20. 20.
    Semprini AE, Vucetich A, Hollander L: Sperm washing, use of HAART and role of elective Caesarean section. Curr Opin Obstet Gynecol 2004, 16:465–470.PubMedCrossRefGoogle Scholar
  21. 21.
    Prasitwattanaseree S, Lallemant M, Costagliola D, et al.: Influence of mother and infant zidovudine treatment duration on the age at which HIV infection can be detected by polymerase chain reaction in infants. Antivir Ther 2004, 9:179–185.PubMedGoogle Scholar
  22. 22.
    Magder LS, Mofenson L, Paul ME, et al.: Risk factors for in utero and intrapartum transmission of HIV. J Acquir Immune Defic Syndr 2005, 38:87–95. Review of large US cohort study of HIV transmission in pregnancy.PubMedCrossRefGoogle Scholar
  23. 23.
    Kaseba-Sata C, Kasolo F, Ichiyama K, et al.: Increased risk of intrauterine transmission of HIV-1 associated with granulocyte elastase in endocervical mucus. J Acquir Immune Defic Syndr 2006, 41:249–251.PubMedCrossRefGoogle Scholar
  24. 24.
    Mullick S, Watson-Jones D, Becksinska M, Mabey D: Sexually transmitted infections in pregnancy: prevalence, impact on pregnancy outcomes, and approach to treatment in developing countries. Sex Transm Infect 2005, 81:294–302.PubMedCrossRefGoogle Scholar
  25. 25.
    World Health Organization: Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants. Guidelines On Care, Treatment And Support For Women Living With HIV/AIDS And Their Children In Resource Constrained Settings. Geneva: World Health Organization; 2004. Current guidelines for use in resource-limited areas.Google Scholar
  26. 26.
    US Public Health Service: PHS Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States. Rockville, MD: Department of Health and Human Services; 2004. Comprehensive review of antiretroviral therapy in pregnant women with case-based scenario guidelines for implementation in the United States.Google Scholar
  27. 27.
    Hawkins D, Blott M, Clayden P, et al.: BHIVA guidelines writing committee: guidelines for the management of HIV infection in pregnant women and the prevention of mother-to-child transmission of HIV. HIV Medicine 2005, 6(Suppl 2):107–148. A comprehensive review of the data on peripartum regimens with recommendations.PubMedCrossRefGoogle Scholar
  28. 28.
    European Collaborative Study: Mother-to-child transmission for HIV infection in the era of highly active antiretroviral therapy. Clin Infect Dis 2005, 40:458–465. A large, long-term cohort study in Western Europe, generating many different types of analyses, supports the role of elective Cesarean section.CrossRefGoogle Scholar
  29. 29.
    Bjorklund K, Mutyaba T, Nabunya E, Mirembe F: Incidence of postcesarean infections in relation to HIV status in a setting with limited resources. Acta Obstet Gynecol Scand 2005, 84:967–971.PubMedCrossRefGoogle Scholar
  30. 30.
    Pacifici GM: Transfer of antivirals across the human placenta. Early Hum Dev 2005, 81:647–654.PubMedCrossRefGoogle Scholar
  31. 31.
    Antiretroviral Pregnancy Registry Steering Committee: Antiretroviral Pregnancy Registry International Interim Report for 11 January 1989 through 31 July 2005. Wilmington, NC: Registry Coordinating Center; 2005. Available at http://www.apregistry.com|url. Ongoing voluntary reporting of fetal exposures to antiretrovirals, with executive summary interpretation of data.Google Scholar
  32. 32.
    Watts DH, Covington DL, Beckerman K, et al.: Assessing the risk of birth defects associated with antiretroviral exposure during pregnancy. Am J Obstet Gynecol 2004, 191:985–992. A critical review of the summary data from the Pregnancy Registry.PubMedCrossRefGoogle Scholar
  33. 33.
    Patel D, Thorne C, Fiore S, et al.: Does highly active antiretroviral therapy increase the risk of congenital abnormalities in HIV-Infected women? J Acquir Immune Defic Syndr 2005, 40:116–118.PubMedCrossRefGoogle Scholar
  34. 34.
    Saitoh A, Hull AD, Franklin P, Spector SA: Myelomeningoceole in an infant with intrauterine exposure to efavirenz. J Perinatol 2005, 25:555–556.PubMedCrossRefGoogle Scholar
  35. 35.
    Morris AB, Dobles AR, Cu-Uvin S: Protease inhibitor use in 233 pregnancies. J Acquir Immune Defic Syndr 2005, 40:30–33.PubMedCrossRefGoogle Scholar
  36. 36.
    Tuomala RE, Watts DH, Li D, et al.: Improved obstetric outcomes and few maternal toxicities are associated with antiretroviral therapy, including highly active antiretroviral therapy during pregnancy. J Acquir Immune Defic Syndr 2005, 38:449–473.PubMedCrossRefGoogle Scholar
  37. 37.
    Thorne C, Patel D, Newell ML: Increased risk of adverse pregnancy outcomes in HIV-infected women treated with highly active antiretroviral therapy in Europe. AIDS 2004, 18:2337–2339.PubMedCrossRefGoogle Scholar
  38. 38.
    Hitti J, Frenkel LM, Stek AM, et al.: Maternal toxicity with continuous nevirapine in pregnancy: Results from PACTG 1022. J Acquir Immune Defic Syndr 2004, 36:772–776.PubMedCrossRefGoogle Scholar
  39. 39.
    Guay LA, Musoke P, Fleming T, et al.: Intrapartum and neonatal single dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 1999, 354:1035–1039. First short-course zidovudine versus single-dose nevirapine pMTCT trial.Google Scholar
  40. 40.
    Lallemant M, Jourdain G, Le Coeur S, et al.: Single-dose perinatal nevirapine plus standard zidovudine to prevent mother-to-child transmission of HIV-1 in Thailand. N Engl J Med 2004, 351:217–228. Innovative approach to combination therapy in resource-limited settings, non-breastfeeding population.PubMedCrossRefGoogle Scholar
  41. 41.
    Leroy V, Sararovitch C, Cortina-Borja M, et al.: Is there a difference in the efficacy of peripartum antiretroviral regimens in reducing mother-to-child transmission of HIV in Africa? AIDS 2005, 19:1865–1875. Useful summary of overall early efficacy of single-agent maternal therapy in varied settings in Africa.PubMedCrossRefGoogle Scholar
  42. 42.
    Eshleman SH, Guay LA, Mwatha A, et al.: Comparison of mother-to-child transmission rates in Ugandan women with subtype A versus D HIV-1 who received single-dose nevirapine prophylaxis: HIV Network for Prevention Trials 012. J Acquir Immune Defic Syndr 2005, 39:593–597.PubMedGoogle Scholar
  43. 43.
    Jourdain G, Ngo-Giang-Huong N, Le Coeur S, et al.: Perinatal HIV Prevention Trial Group. Intrapartum exposure to nevirapine and subsequent maternal responses to nevirapine-based antiretroviral therapy. New Engl J Med 2004, 351:229–240. Limitations of nevirapine-based prophylaxis regarding future treatment options for mothers.PubMedCrossRefGoogle Scholar
  44. 44.
    Lallemant M: Response to therapy after prior exposure to nevirapine [abstract TuFo0205]. Paper presented at the 3rd International AIDS Society Conference on Pathogenesis and Treatment. Rio de Janeiro, Brazil; July 24–27, 2005.Google Scholar
  45. 45.
    Muro E, Droste JA, Hofstede HT, et al.: Nevirapine plasma concentrations are still detectable after more than 2 weeks in the majority of women receiving single-dose nevirapine: implications for intervention studies. J Acquir Immune Defic Syndr 2005, 39:419–421.PubMedCrossRefGoogle Scholar
  46. 46.
    Cressey TR, Jourdain G, Lallemant M, et al.: Persistence of nevirapine exposure during the post partum period after intrapartum single dose nevirapine in addition to zidovudine prophylaxis for the prevention of mother to child transmission of HIV-1. J Acquir Immune Defic Syndr 2005, 38:283–288.PubMedGoogle Scholar
  47. 47.
    McIntyre JA, Martinson N, Gray GE, et al.: Addition of short course Combivir to single dose Viramune for the prevention of mother to child transmission of HIV-1 can significantly decrease the subsequent development of maternal and paediatric NNRTI-resistant virus [abstract TuFo0204]. Paper presented at the 3rd International AIDS Society Conference on Pathogenesis and Treatment. Rio de Janeiro, Brazil; July 24–27, 2005. A strategy for reducing single-dose nevirapine-associated drug resistance.Google Scholar
  48. 48.
    Chaix ML, Dabis F, Ekouevi D, et al.: Addition of 3 days of ZDV+3TC postpartum to a short course of ZDV+3TC and single-dose NVP provides low rate of NVP resistance mutations and high efficacy in preventing peri-partum HIV-1 transmission: ANRS DITRAME PLUS, Abidjan, Côte d‘Ivoire [abstract 72LB]. Paper presented at the 12th Conference of Retroviruses and Opportunistic Infections. Boston, MA; February 22–25, 2005.Google Scholar
  49. 49.
    Shapiro R, Thior I, Gilbert P, et al.: Maternal single-dose nevirapine may not be needed to reduce mother-to-child HIV transmission in the setting of maternal and infant zidovudine and infant single-dose nevirapine: results of a randomized clinical trial in Botswana [abstract 74LB]. Paper presented at the 12th Conference of Retroviruses and Opportunistic Infections. Boston, MA; February 22–25, 2005.Google Scholar
  50. 50.
    Becquet R, Ekouevi DK, Sakarovitch C, et al.: Knowledge, attitudes, and beliefs of health care workers regarding alternatives to prolonged breast-feeding (ANRS 1201/1202, Ditrame Plus, Abidjan, Cote d‘Ivoire). J Acquir Immune Defic Syndr 2005, 40:102–105.PubMedCrossRefGoogle Scholar
  51. 51.
    Gaillard P, Fowler MG, Dabis F, et al.: Use of antiretroviral drugs to prevent HIV-1 transmission through breastfeeding: from animal studies to randomized clinical trials. J Acquir Immune Defic Syndr 2004, 35:178–187. Useful review of the data on breastfeeding-associated MTCT.PubMedCrossRefGoogle Scholar
  52. 52.
    Shapiro RL, Holland DT, Capparelli E: Antiretroviral concentrations in breast-feeding infants of women in Botswana receiving antiretroviral treatment. J Infect Dis 2005, 192:720–727.PubMedCrossRefGoogle Scholar
  53. 53.
    Shapiro RL, Ndung‘u T, Lockman S, et al.: Highly active antiretroviral therapy started in pregnancy or postpartum suppresses HIV -1 RNA but not DNA, in breast milk. J Infect Dis 2005, 192:713–719.PubMedCrossRefGoogle Scholar
  54. 54.
    Severe P, Leger P, Charles M, et al.: Antiretroviral therapy in a thousand patients with AIDS in Haiti. New Engl J Med 2005, 353:2325–2334.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.Department of International Medicine and Infectious Diseases, Weill Cornell Medical College of Cornell University and the Center for Special Studies Rogers UnitNew York Presbyterian HospitalNew YorkUSA

Personalised recommendations