Prevention of mother-to-child transmission of HIV Type 1: the role of neonatal and infant prophylaxis

Abstract

Summary The prevention of mother-to-child transmission (PMTCT) of HIV is one of the great public health successes of the past 20 years. Much concerted research efforts and dedicated work have led to the achievement of very low rates of PMTCT of HIV in settings that can implement optimal prophylaxis. Though several implementation challenges remain, global elimination of pediatric HIV infection seems now more than ever to be an attainable goal. Often overlooked, the role of prophylaxis of the newborn is nevertheless a very important component of PMTCT. In this paper, we focus on the role of neonatal and infant prophylaxis, discuss mechanisms of protection, and present the clinical trial-generated evidence that led to the current recommendations for preventing infections in breastfed and nonbreastfed infants. PMTCT of HIV should not end at birth; a continuum of care extending postpartum and postnatally is required to minimize the risk of new pediatric HIV infections.

Infant peripheral blood repetitive element hypomethylation associated with antiretroviral therapyin utero

“…The use of combination antiretroviral therapy (cART) during pregnancy has resulted in a dramatic reduction in HIV motherto-child transmission. [1][2][3] The use of cART is generally considered safe, with the benefits of HIV prevention far exceeding potential safety concerns from in utero exposure to these drugs. 1,[4][5][6][7] However, there is still a continued need to monitor HIV-exposed, uninfected infants for potential adverse effects from in utero and postnatal exposure to these therapies.…”

Point-of-care diagnostics to improve maternal and neonatal health in low-resource settings

“…32 POC devices that make maternal HIV diagnosis as rapid and simple as possible are of high importance and have been the target of much funding and research over the past 20 years. 33 With effective diagnosis, women with HIV can receive appropriate prophylactic strategies to reduce viral load, both for their health and the health of the neonate. Ninety percent of HIV infections in children are due to mother-to-child transmission.…”

“…32 However, the prevention of mother-to-child-transmission (PMTCT) of HIV is one of the great public health successes of the past 20 years. 33 The vertical transmission rate for HIV-positive pregnant women with no intervention is 25–42%, but this rate has been reduced to 1% or less when all prophylactic strategies are implemented. 33 Precautions including antiretroviral therapy (ART) during pregnancy, labor and delivery, and the postnatal period to the infant, as well as elective cesarean delivery, have contributed to this success.…”

Characterization of the Epidemiological Profile and Survival of Children with AIDS in Santa Catarina, Brazil, 1988 - 2013

“…Eastern Europe and Central Asia 5,700 (4,800 -6,900) < 1,000 (< 500 ≤ 1,000) < 500 (< 200 ≤ 500) agnosis, screening can occur later, and it often only takes place in the third trimester or at delivery; in these cases, a rapid screening for HIV infection should be performed (7). In Brazil, HIV testing has been provided to all parturient women in maternity units since 2001, which allows for diagnosis and preventive measures to reduce the perinatal transmission of HIV (8).…”