Elimination of perinatal HIV infection in the USA and other high-income countries

Abstract

Purpose of review To describe progress and challenges to elimination of mother-to-child HIV transmission (EMCT) in high-income countries. Recent findings Despite ongoing declines in the number of perinatally HIV-infected infants in most high-income countries, the number of HIV-infected women delivering may be increasing, accompanied by apparent changes in this population, including higher percentages with antiretroviral “pre-treatment” (with possible antiretroviral resistance), other co-infections, mental health diagnoses, and recent immigration. The impact of antiretroviral resistance on mother-to-child transmission is yet to be defined. A substantial minority of infant HIV acquisitions occur in the context of maternal acute HIV infection during pregnancy. Some infant infections occur after pregnancy, e.g., by premastication of food, or breastfeeding (perhaps by an uninfected woman who acquires HIV while breastfeeding). Summary The issues of EMCT are largely those of providing proper care for HIV-infected women. Use of combination antiretroviral therapy by increasing proportions of the infected population may function as a structural intervention important to achieving this goal. Providers and public health systems need to be alert for HIV-serodiscordant couples in which the woman is uninfected and for changes in the population of HIV-infected pregnant women. Accurate data about HIV-exposed pregnancies is vital to monitor progress toward EMCT.

Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000–2011

“…MTCT rates of 0.5-1% have been reported from observational cohort studies in other resource-rich settings in Europe and North America[6,[31][32][33][34][35]. However, to our knowledge, such low rates have not been previously achieved in such a large unselected population.…”

Contemporary Management of Human Immunodeficiency Virus in Pregnancy

“…1 Now, more than 3 decades later, perinatal transmission in resource-rich settings has become uncommon and the goal of elimination of perinatal HIV transmission may be possible in the foreseeable future. [2][3][4] This review covers key concepts in the pathophysiology of HIV, with emphasis on perinatal transmission, and reviews appropriate screening and diagnostic testing for HIV during pregnancy. Current recommendations for medical, pharmacologic, and obstetric management of women newly diagnosed with HIV during pregnancy and women with preexisting infection, with an emphasis on the resource-rich setting, are also discussed.…”

Ending Sexual HIV Transmission: Lessons Learned from Perinatal HIV

“…Several interventions led to this success: (a) routine prenatal HIV screening, (b) rapid HIV testing during labor and delivery, (c) maternal ART and infant ART prophylaxis, and (d) infant replacement feeding. Vital work remains to maintain these successes and achieve the elimination of perinatally transmitted HIV (Nesheim, Harris, & Lampe, 2013).…”