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Introduction In resource-constrained settings, infant feeding decisions among women with HIV (WHIV) must balance the risk of infant HIV acquisition from breastfeeding with increased mortality associated with formula feeding. WHO guidelines recommend countries principally promote a single feeding method for WHIV, either breastfeeding or formula feeding. In 2016, Botswana revised its policy of formula feeding for infants born to WHIV, instead promoting exclusive breastfeeding during the first 6 months of life. Methods We sought to understand factors influencing infant feeding choices among WHIV by administering a questionnaire to pregnant and postpartum WHIV (2013-2015) participating in a clinical trial in Botswana (the Mpepu Study). Logistic regression analyses were used to identify factors associated with infant feeding choices. Results Of 810 surveyed participants, 24.0% chose breastfeeding and 76.0% chose formula feeding. Women were more likely to choose formula feeding if advised by a health worker to formula feed (aOR 1.90; 95% CI 1.02-3.57) or if they harboured doubts about the potency of antiretroviral treatment (ART) to prevent infant HIV acquisition (aOR 9.06; 95% CI 4.78-17.17). Women who reported lack of confidence in preparing infant formula safely (aOR 0.09; 95% CI 0.04-0.19) or low concerns about infant HIV acquisition (aOR 0.35; 95% CI 0.22-0.55) were significantly less likely to formula feed. Discussion Perceptions about ART effectiveness, social circumstances and health worker recommendations were key influencers of infant feeding choices among WHIV. Health system factors and maternal education interventions represent ideal targets for any programmatic actions aiming to shape informed decision-making towards HIV-free survival of infants., Author(s): Aamirah Mussa [sup.1] , Henock B. Taddese [sup.2] , Ekaterina Maslova [sup.2] , Gbolahan Ajibola [sup.1] , Joseph Makhema [sup.1] , Roger L. Shapiro [sup.1] [sup.3] , Shahin Lockman [...]

: Introduction: Mentor Mothers (MM) provide peer support to pregnant and postpartum women living with HIV (PPWH) and their infants with perinatal HIV exposure (IPE) throughout the cascade of prevention of vertical transmission (PVT) services. MM were implemented in Zambézia Province, Mozambique starting in August 2017. This evaluation aimed to determine the effect of MM on PVT outcomes. Methods: A retrospective interrupted time series analysis was done using routinely collected aggregate data from 85 public health facilities providing HIV services in nine districts of Zambézia. All PPWH (and their IPE) who initiated antiretroviral therapy (ART) from August 2016 through April 2019 were included. Outcomes included the proportion per month per district of: PPWH retained in care 12 months after ART initiation, PPWH with viral suppression and IPE with HIV DNA PCR test positivity by 9 months of age. The effect of MM on outcomes was assessed using logistic regression. Results: The odds of 12‐month retention increased 1.5% per month in the pre‐MM period, compared to a monthly increase of 7.6% with‐MM (35–61% pre‐MM, 56–72% with‐MM; p < 0.001). The odds of being virally suppressed decreased by 0.9% per month in the pre‐MM period, compared to a monthly increase of 3.9% with‐MM (49–85% pre‐MM, 59–80% with‐MM; p < 0.001). The odds of DNA PCR positivity by 9 months of age decreased 8.9% per month in the pre‐MM period, compared to a monthly decrease of 0.4% with‐MM (0–14% pre‐MM, 4–10% with‐MM; p < 0.001). The odds of DNA PCR uptake (the proportion of IPE who received DNA PCR testing) by 9 months of age were significantly higher in the with‐MM period compared to the pre‐MM period (48–100% pre‐MM, 87–100% with‐MM; p < 0.001). Conclusions: MM services were associated with improved retention in PVT services and higher viral suppression rates among PPWH. While there was ongoing but diminishing improvement in DNA PCR positivity rates among IPE following MM implementation, this might be explained by increased uptake of HIV testing among high‐risk IPE who were previously not getting tested. Additional efforts are needed to further optimize PVT outcomes, and MM should be one part of a comprehensive strategy to address this critical need., INTRODUCTION Prevention of vertical transmission of HIV (PVT) services are essential to decreasing new HIV infections among children. The cascade of PVT services includes lifelong antiretroviral therapy (ART) for pregnant [...]

Introduction The Democratic Republic of the Congo (DRC) had the second-highest mother-to-child HIV transmission rate in Sub-Saharan Africa at 29% in 2013, however the uptake of preventive services for mother-to-child transmission of HIV (PMTCT) remains suboptimal. This systematic review explores socio-cultural and structural factors influencing PMTCT service uptake in the DRC. Methods We conducted a search of electronic databases. The PEN-3 model was used as a framework to synthesize factors influencing PMTCT service uptake into perceptions, enablers, and nurturers. Results Sixteen studies, 14 quantitative and two qualitative, were retained. Maternal, socio-economic, structural, and cultural factors were found to influence PMTCT service uptake in the DRC. Cost, accessibility, and quality of PMTCT services were key barriers to service uptake. Integration, male partner involvement, and evolving PMTCT policies improved PMTCT service delivery and uptake. This review also revealed several socio-cultural challenges in involving male partners in PMTCT programs. Discussion Findings highlight the need to address barriers and reinforce enablers of PMTCT uptake. Creating culturally appropriate, male-friendly, and family-oriented PMTCT programs will improve service uptake in the DRC., Author(s): Guy-Lucien S. Whembolua [sup.1] , Baraka Muvuka [sup.2] , Daudet Ilunga Tshiswaka [sup.3] , Donaldson F. Conserve [sup.4] Author Affiliations: (Aff1) 0000 0001 2179 9593, grid.24827.3b, Department of Africana [...]

: Introduction: Findings from biomedical, behavioural and implementation studies provide a rich foundation to guide programmatic efforts for the prevention of mother‐to‐child HIV transmission (PMTCT). Methods: We summarized the current evidence base to support policy makers, programme managers, funding agencies and other stakeholders in designing and optimizing PMTCT programmes. We searched the scientific literature for PMTCT interventions in the era of universal antiretroviral therapy for pregnant and breastfeeding women (i.e. 2013 onward). Where evidence was sparse, relevant studies from the general HIV treatment literature or from prior eras of PMTCT programme implementation were also considered. Studies were organized into six categories: HIV prevention services for women, timely access to HIV testing, timely access to ART, programme retention and adherence support, timely engagement in antenatal care and services for infants at highest risk of HIV acquisition. These were mapped to specific missed opportunities identified by the UNAIDS Spectrum model and embedded in UNICEF operational guidance to optimize PMTCT services. Results and discussion: From May to November 2019, we identified numerous promising, evidence‐based strategies that, properly tailored and adopted, could contribute to population reductions in vertical HIV transmission. These spanned the HIV and maternal and child health literature, emphasizing the importance of continued alignment and integration of services. We observed overlap between several intervention domains, suggesting potential for synergies and increased downstream impact. Common themes included integration of facility‐based healthcare; decentralization of health services from facilities to communities; and engagement of partners, peers and lay workers for social support. Approaches to ensure early HIV diagnosis and treatment prior to pregnancy would strengthen care across the maternal lifespan and should be promoted in the context of PMTCT. Conclusions: A wide range of effective strategies exist to improve PMTCT access, uptake and retention. Programmes should carefully consider, prioritize and plan those that are most appropriate for the local setting and best address existing gaps in PMTCT health services., INTRODUCTION Significant achievements have been made in the prevention of mother‐to‐child HIV transmission (PMTCT), transforming the paediatric HIV epidemic globally. With new innovations, strong political will and rapid programme expansion, [...]

: Introduction: In 2011, Malawi implemented “Option B+,” a test‐and‐treat strategy for the prevention of maternal to child transmission of HIV (PMTCT); however limited data on viral load (VL) suppression exist. We describe VL suppression in HIV‐infected women at four to twenty‐six weeks postpartum, factors associated with VL suppression and the impact of VL suppression levels on MTCT. Methods: HIV‐positive mothers at four to twenty‐six weeks postpartum were enrolled in a nested cross‐sectional study within the “National Evaluation of Malawi's PMTCT Programme” cohort study between October 2014 and May 2016. HIV‐exposed infants received HIV‐1 DNA testing and venous samples determined maternal VL, classified as unsuppressed (>1000 copies/mL), low‐detectable (40 to 1000 copies/mL) or undetectable ( Results: Of the 1274 women, 1191 (93.5%) knew their HIV status and 1154/1191 (96.9%) were on ART. VL was available for 1124/1154 (97.4%) of women on ART: 988/1124 (87.9%) had VL suppression of whom 86 (8.7%) had low‐detectable and 902 (91.3%) undetectable VL. Suboptimal adherence was associated with unsuppressed VL (vs. suppressed VL; aOR 3.1, 95% CI 2.0 to 4.9; p < 0.001). Women with low‐detectable VL were more likely to be adolescent (vs. undetectable VL; aOR 3.0, 95% CI 1.4 to 6.6), on ART Conclusions: Unsuppressed and low‐detectable VL was strongly predictive of MTCT among women on ART and associated with suboptimal adherence. This urges further consideration of optimal VL monitoring and target levels to reach elimination of paediatric infection., Introduction In 2011, Malawi implemented “Option B+,” a universal test and treat strategy for all pregnant and breastfeeding women for the prevention of mother‐to‐child‐transmission (PMTCT) of HIV. Option B+ has [...]

: Globally, 150,000 new paediatric human immunodeficiency virus type 1 (HIV‐1) infections occurred in 2015. There remain complex challenges to the global elimination of paediatric HIV‐1 infection. Thus, for the global community to achieve elimination of new paediatric HIV‐1 infections, innovative approaches need to be explored. Immune‐based approaches to prevention of mother‐to‐child transmission (MTCT) may help fill some of the remaining gaps and provide new opportunities to achieve an AIDS‐free generation. Immune‐based interventions to prevent MTCT of HIV‐1 may include paediatric HIV vaccines and passive immunization approaches. Recent discoveries providing evidence of robust immune responses to HIV in infants open new and exciting prospects for paediatric HIV vaccines. Moreover, successful vaccination of infants has a different set of requirements than vaccination of adults and may be easier to achieve. Proof‐of‐concept has been established over the last two decades that passively administered HIV‐1 Env‐specific monoclonal antibody (mAbs) can prevent chimeric simian human immunodeficiency virus (SHIV) transmission to newborn nonhuman primates. There has been tremendous progress in isolating and characterizing broadly neutralizing antibodies to HIV, and clinical testing of these antibodies for treatment and prevention in both infants and adults is a major effort in the field. Immune‐based interventions need to be actively explored as they can provide critically important tools to address persistent challenges in MTCT prevention. It is a pivotal time for the field with active discussions on the best strategy to further reduce HIV infection of infants and accomplish the World Health Organization Fast‐Track 2030 goals to eliminate new paediatric HIV infections., Challenges in preventing mother‐to‐child HIV‐1 transmission Globally, 150,000 new paediatric human immunodeficiency virus type 1 (HIV‐1) infections occurred in 2015. This number represents a remarkable 70% decrease since the year [...]

Background: Despite the centrality of family in Indian society, relatively little is known about family‐based communication concerning sexual behaviour and HIV/AIDS in rural Indian families. To date, very few family‐based adolescent HIV‐prevention interventions have been developed for rural Indian youth. This study conducted formative research with youth aged 14 to18 years and their parents in order to assess the feasibility of conducting a family‐based HIV‐prevention intervention for rural Indian adolescents. Methods: Eight focus groups were conducted (n = 46) with mothers, fathers, adolescent females and adolescent males (two focus groups were held for each of the four groups). All focus groups consisted of same‐gender participants. Adolescents aged 14 to18 years old and their parents were recruited from a tribal community in rural Maharashtra, India. Focus group transcripts were content analyzed to identify themes related to family perceptions about HIV/AIDS and participation in a family‐based intervention to reduce adolescent vulnerability to HIV infection. Results: Six primary thematic areas were identified: (1) family knowledge about HIV/AIDS; (2) family perceptions about adolescent vulnerability to HIV infection; (3) feasibility of a family‐based programme to prevent adolescent HIV infection; (4) barriers to participation; (5) recruitment and retention strategies; and (6) preferred content for an adolescent HIV prevention intervention. Conclusion: Despite suggestions that family‐based approaches to preventing adolescent HIV infection may be culturally inappropriate, our results suggest that a family‐based intervention to prevent adolescent HIV infection is feasible if it: (1) provides families with comprehensive HIV prevention strategies and knowledge; (2) addresses barriers to participation; (3) is adolescent friendly, flexible and convenient; and (4) is developmentally and culturally appropriate for rural Indian families., Background Preventing the transmission of HIV in India remains a significant goal for global public health. In 2007, an estimated 2.4 million Indians were living with HIV [1]. Among the [...]

Byline: Caroline E. Boeke (Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland); J. Brooks Jackson, MD (Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, bjackso@jhmi.edu) Keywords: HIV-1; prevention [...]

Adherence to antiretroviral therapy (ART) in pregnancy is crucial to optimize its efficacy and minimize mother-to-child transmission. Our objective was to examine adherence patterns to ART and health behaviors during and after pregnancy among HIV-positive women enrolled in A5084, a prospective, observational, multisite study. Between 2002-2005, HIV-infected women between 20 and 34 weeks' gestation completed at least I self-reported adherence questionnaire antepartum (AP), and were followed through 12 weeks' postpartum (PP). Questionnaires also addressed tobacco, alcohol, and illicit drugs use. Adherence was defined as reporting not having missed any doses for more than 3 months. Exact McNemar's tests were used for paired binary data and exact logistic regression was used for predictors of nonadherence. We report on 149 women (55% black, 26% Hispanic, 32% less than 25 years, 9% with AIDS, 100% on ART). PP, 31 (21%) women stopped ART and 18 (12%) withdrew from the study. AP, 57% reported adherence to ART and PP, 45% (p = 0.03, n = 87). AP, 11% reported ongoing alcohol use and 23% tobacco use compared to 37% and 30% PP (p < 0.0001, n = 103; p = 0.07, n = 99, respectively). Although 39% ever used marijuana (n = 116) and 25% used illicit drugs (n = 107), few participants reported use during the study. In multivariate analyses, those who had ever used illicit drugs had 5.95 times higher odds (p = 0.002) and those who missed prenatal vitamins had 4.84 times higher odds (p = 0.001) of ART nonadherence. Women reporting a history of illicit drug use and/or having missed prenatal vitamins should be targeted for programs to enhance adherence to ART during pregnancy.

ABSTRACT Background Highly active antiretroviral treatment (HAART) has only been recently recommended for HIV-infected pregnant women requiring treatment for their own health in resource-limited settings. However, there are few documented [...]

A simple method of flash-heat to inactivate HIV in naturally infected breast milk from HIV-positive mothers is investigated. It is indicated that flash-heat is capable of inactivating cell-free HIV-1 in naturally infected breast milk from HIV-positive women.

The impact of the introduction of routine opt-out HIV testing in antenatal care in Botswana is examined. The results have shown that routine HIV testing is more accepted than voluntary testing and it has led to substantial increases in the uptake of testing and prevention of mother-to-child transmission (PMTCT) interventions without adverse consequences.

Hematologic alterations observed during the first 3 months of life in HIV-exposed uninfected infants subjected to antiretroviral medication before and after birth is investigated. The results have shown that antiretroviral transmission prophylaxis is associated with anemia and neutropenia in HIV-uninfected infants during the first 3 months of life and also that anemia is more profound in highly active antiretroviral therapy (HAART)-exposed infants.

ABSTRACT Background Little is known about the long-term safety of infant feeding interventions aimed at reducing breast milk HIV transmission in Africa. Methods and Findings In 2001-2005, HIV-infected pregnant women [...]

The introduction of a program for prevention of mother-to-child transmission (PMTCT) of HIV in Nouna, rural Burkina Faso led to the determination of HIV prevalence in this region to be 3.6% which is significantly lower than the 7% reported for 2 major cities of Burkina Faso. Resistance-associated polymorphisms were prevalent in the complete protease region, but no primary drug resistance mutations were detected.

A study was conducted to determine the predictors of failure to return for HIV posttest results among pregnant women receiving antenatal care at primary health clinics in Moshi urban district, Tanzania. Results indicated that male partner factors were important in determining whether women returned for test results.

Simian immunodeficiency virus (SIV) infection of infant macaques is a useful animal model of pediatric HIV infection to evaluate the potential of chemoprophylactic regimens to reduce mother-to-infant transmission of HIV. Studies have revealed that topical administration of a low dose of the second-generation tenofovir prodrug GS-7340 did not have detectable prophylactic efficacy, while oral administration of tenofovir disoproxil fumarate lowered the infection rate at birth, but had lower efficacy against virus infection at 4 weeks of age.

ABSTRACT Background A Phase I clinical trial has been proposed that uses neutralising monoclonal antibodies (MAbs) as passive immunoprophylaxis to prevent mother-to-child transmission of HIV-1 in South Africa. To assess [...]

The preliminary efficacy of four different short-course nucleoside analogue regimens, stavudine (d4T), didanosine (ddI), d4T+ddI, and zidovudine are reported for the prevention of mother-to-child transmission of HIV-1 in a response-limited setting. The use of monotherapy in the study afforded the opportunity to demonstrate the relative intrinsic activity of several nucleoside analogues, while the results suggested that of the three nucleoside analogues evaluated in monotherapy, ddI was the most potent.

Routine HIV counseling and testing (HCT) during labor is proposed as a way to increase prevention of mother-to-child HIV transmission (PMTCT) uptake. Analysis concluded that intrapartum HCT might be an acceptable and feasible way to increase individual and couple participation in PMTCT interventions.

The predictors and extent of non-adherence to single-dose nevirapine are investigated to ensure the proper adherence for the prevention of mother-to-child transmission of HIV (pMTCT) programs to be effective. The results show that the place of birth and the poor health status of the newborn highly affect the nonadherence, which can be minimized by using nevirapine in the clinical protocols as well as the pMTCT programs.

The Cameroon Bapist Convention Health Board implemented to prevent mother-to-child transmission of HIV-1 into routine antenatal care, achieved high uptake of rapid HIV testing and posttest counseling on the same day, implemented routine uses on peripartum single-dose NVP for HIV-positive mothers and their infants in collaboration with the National AIDS Program is described. Consistent training and programmatic support contributed to rapid upscaling and high uptake counseling rates.

A study was conducted to investigate the knowledge of health care workers concerning infant feeding practices and their attitude and beliefs regarding the alternatives to prolonged and predominant breast-feeding, within the prevention of mother-to-child transmission (PMTCT) project in Abidjan Cote d'Ivoire. However, findings suggest that proposing alternatives to prolonged breast-feeding causes difficulties for health care workers that should be taken into account when tailoring such complex interventions.

A study demonstrates that HIV-1 subtype can influence emergence and fading of specific nevirapine resistance (NVPR) mutations after single-dose NVP exposure. Rapid fading of variants with Y181C mutation was observed for women with subtype A, but not for women with subtype D.

A test was conducted to determine whether data from voluntary counseling and testing (VCT)/ prevention of mother-to-child transmission (PMTCT) programs can be used for HIV surveillance. There was a bias to accepting VCT in women with HIV, or risk factors for HIV infection, the former most apparent when there was low coverage.

A nested case-control study of 32 HIV-positive women who transmitted HIV to their infants and 52 randomly selected HIV-positive women who did not transmit HIV to their infants is conducted in Lusaka, Zambia, where alpha-defensins are detected in most of the milk samples tested. It is suggested that there may be a role for alpha-defensins in prevention of HIV transmission to breastfed infants.

A program to provide maternal and newborn doses of nevirapine to pregnant women in rural Uganda is conducted to assess the effectiveness of maternal self-administration of nevirapine for prevention of mother-to-child transmission (MTCT) of HIV. Women provided blood for HIV testing and were offered voluntary counseling and testing (VCT) during annual community HIV surveys.

Nevirapine (NVP) plasma levels during the postpartum period after a single intrapartum NVP dose for the prevention of mother-to-child transmission is determined. Plasma NVP concentrations around the IC(super 50) might persist in some women for as long as 4 weeks after administration of single intrapartum NVP doses.

In developed countries, care and treatment are available for pregnant women and infants that can decrease the rate of perinatal human immunodeficiency virus type 1 (HIV-1) infection to 2% or less. The pediatrician has a key role in prevention of mother-to-child transmission of HIV-1 by identifying HIV-exposed infants whose mothers&apos; HIV infection was not diagnosed before delivery, prescribing antiretroviral prophylaxis for these infants to decrease the risk of acquiring HIV-1 infection, and promoting avoidance of HIV-1 transmission through human milk. In addition, the pediatrician can provide care for HIV-exposed infants by monitoring them for early determination of HIV-1 infection status and for possible short- and long-term toxicities of antiretroviral exposure, providing chemoprophylaxis for Pneumocystis pneumonia, and supporting families living with HIV-1 infection by providing counseling to parents or caregivers. Pediatrics 2004;114:497-505; HIV-1, mother-to-child transmission, HIV-exposed infants, antiretroviral, diagnosis., ABBREVIATIONS. HIV, human immunodeficiency virus; AAP, American Academy of Pediatrics; EIA, enzyme immunoassay; ZDV, zidovudine; NVP, nevirapine; 3TC, lamivudine; TB, tuberculosis; PCR, polymerase chain reaction; PCP, Pneumocystis pneumonia. INTRODUCTION The [...]

The Center for Disease Prevention and Control (CDC) says that annually around 350 infants human immunodeficiency virus (HIV) affected children are born in the US and a test was conducted to determine the feasibility and acceptance of rapid HIV testing among women in labor. It was found that rapid HIV testing was feasible since it gives accurate, timely results for women in labor and it also provides infected women immediate access to emergency drugs.

Thailand implemented a nationwide program in 2000 to offer voluntary, confidential HIV testing to all pregnant women, to treat those who test positive, and to treat their babies. The program was more widely available to women who were receiving prenatal care., Context Each year in Thailand, about 10000 children are born at risk for mother-to-child human immunodeficiency virus (HIV) transmission. In 2000, Thailand implemented a national program to prevent mother-to-child HIV transmission. Objective To describe the results of implementation of the program. Design Monthly collection of summary data from hospitals. Setting Public health hospitals (n=822) in all 12 regions of Thailand, representing 75 provinces, excluding Bangkok. Participants Women giving birth from October 2000 through September 2001, including HIV-seropositive women and their neonates. Main Outcome Measures Percentages of women giving birth who were tested for HIV, HIV-seropositive women giving birth who received antenatal prophylactic antiretroviral drugs, and HIV-exposed neonates who received prophylactic antiretroviral drugs and infant formula. Results Among 573655 women (range, 27344-77806 by region) giving birth, 554912 (96.7%) received antenatal care (range, 91.9% -98.8% by region). Of 554912 women giving birth who had antenatal care, 517488 (93.3%) were tested for HIV (range, 87.7%-99.4% by region) before giving birth; of 18743 women giving birth who did not have antenatal care, 13314(71.0%) were tested for HIV (range, 21.7%-92.9% by region). Of 6646 HIV-seropositive women giving birth, 4659 (70.1%) received prophylactic antiretroviral drugs before delivery (range, 55.3%-81 .2% by region). Of 6475 neonates of HIV-seropositive women, 5741 (88.7%) received prophylactic antiretroviral drugs (range, 67.4%-96.9% by region) and 5386 (83.2%) received infant formula (range, 65.3%-100% by region). Conclusions Major program components of Thailand&apos;s national program for preventing mother-to-child HIV transmission were implemented. Thailand&apos;s experience may encourage other developing countries to implement or expand similar national programs.

Pregnant women with HIV infection do not need to take nevirapine if they are already taking zidovudine or other AIDS drugs. These drugs are used to prevent the virus from passing to the baby during childbirth. In a study of 1,170 women, nevirapine did not lower the risk of transmission more than traditional AIDS drugs do., Context: A 2-dose intrapartum/newborn nevirapine regimen reduced perinatal human immunodeficiency virus (HIV) transmission in Ugandan women not receiving antenatal antiretroviral therapy (ART). However, it is unknown whether the addition of the 2-dose nevirapine regimen to standard ART would further reduce perinatal HIV transmission. Objective: To determine whether a 2-dose nevirapine regimen can decrease perinatal transmission of HIV in nonbreastfeeding women receiving standard ART. Design and Setting: International, blinded, placebo-controlled, phase 3 trial enrolling women between May 1997 and June 2000 at clinical sites providing care for HIV infection throughout the United States, Europe, Brazil, and the Bahamas. Participants: A total of 1270 women received nevirapine (n=642) or placebo (n=628). Infants were followed up for 6 months to determine HIV-infection status, which was available for 1248 deliveries. Intervention: A 200-mg dose of oral nevirapine to women after onset of labor and a 2-mg/kg dose of oral nevirapine to newborns between 48 and 72 hours after birth. Main Outcome Measures: Detection of HIV infection in infants and grade 3 and 4 toxic effects in women and newborns. Results: After review by the data and safety monitoring board, the trial was stopped early because the overall transmission rates were significantly lower than assumed for the study design. Antenatal ART included zidovudine alone in 23%; combinations without protease inhibitors in 36%; and combinations with protease inhibitors in 41%. Thirty-four percent of women had elective cesarean delivery. No significant safety concerns were identified for women or infants. Detection of HIV infection occurred in 9 (1.4%; 95% confidence interval [CI], 0.6%-2.7%) of 631 nevirapine group deliveries and 10 (1.6%; 95% CI, 0.8%-2.9%) of 617 placebo group deliveries. The 95% CI for the difference in transmission rate (-0.2) between the 2 study arms ranged from -1.5% in favor of nevirapine to 1.2% in favor of placebo (P=.82, Fisher exact test). The transmission rate was higher in women with lower baseline CD4 cell counts and higher delivery HIV RNA levels, but there was no significant difference between treatment arms in any sub group. Conclusion: Risk of perinatal HIV transmission was low and no benefit from additional intrapartum/newborn nevirapine was demonstrated when women received prenatal care and antenatal ART, and elective cesarean section was made available.

Research on methods for preventing HIV transmission from pregnant women to their babies in developing countries focuses on breastfeeding, the potential toxicity of AIDS drugs to the fetus, and the development of drug resistance on the part of the virus. Between 15% and 40% of pregnant women in eastern and southern Africa are HIV-positive.

A combination of AIDS drugs taken during pregnancy and labor can substantially lower the risk that an HIV-infected pregnant woman will transmit the virus to her baby. In a study of 1,542 HIV-infected pregnant women, 1% of those who took highly active antiretroviral therapy (HAART) transmitted the virus to their baby, compared to 20% of those who took no medication and 10% who took zidovudine.

The availability of interventions to reduce perinatal HIV transmission has led to nationwide efforts to encourage pregnant women to learn their HIV status. (1-3) The challenge has been to provide […]

Since 1999, many African governments have launched programs to offer short-course antiretroviral drug regimens to reduce mother-to child transmission of HIV. HIV testing in prenatal care is the gateway to these antiretroviral regimens. Pilot projects in Africa show an uptake of antiretroviral drugs in 8% to 50% of pregnant women presumed to be HIV infected; often, a minority of eligible women in care received these regimens. Use of lay counselors and rapid onsite HIV testing may alleviate health service barriers. Community education to promote voluntary counseling and testing, which involves men, is the long-term solution. In the short term, possibilities to enhance delivery of an effective intervention include group pretest counseling, universal offer of testing with women having the right to 'opt out,' universal treatment (mass treatment for those whose HIV status is not determined by voluntary counseling and testing), universal testing with women having the right to 'opt out' of learning their test results, and mass treatment for all without testing.

HIV counseling and testing of pregnant women in Sub-Saharan Africa are discussed based on a study on prevention of mother-to-child HIV-1 transmission in Tanzania. It was found that improvements in counseling are needed. The study sought to determine acceptability of HIV counseling and testing and participation in a mother-to-child HIV-1 transmission intervention study using antiretroviral therapy; and 76.4% of the women agreed to be tested, with prevalence of infection 13.7% and 68.1% returning for results. Only 16.7% of the enrolled women disclosed positive status to sexual partners. Other data are given, including pregnancy recurrence rate and the percentage not wanting to carry to term.

In June 2001 the United Nations Special Assembly on HIV/AIDS set reduction targets of 20% and 50% for the numbers of children newly infected with HIV by 2005 and 2010 respectively. Are these targets achievable? Antiretroviral monotherapy during pregnancy, delivery, and the neonatal period can reduce the rate of mother-to-child transmission of HIV-1 by two-thirds in non-breastfeeding populations. Shorter and simpler regimens of monotherapy have been associated with a reduction of 50% in such transmission among non-breastfeeding populations and of up to 40% in breastfeeding populations. Delivery by elective caesarean section is associated with a halving of the risk of mother-to-child transmission. However, breastfeeding poses a substantial additional risk of acquisition of HIV, and if prolonged it more than doubles the overall rate of transmission. Rates below 2% are being reported from settings where combination therapy is applied during pregnancy and delivery, delivery is by elective caesarean section, and breastfeeding does not take place. In breastfeeding populations where elective caesarean delivery is not an option but peripartum antiretroviral therapy is used, rates at six weeks are about 10% but can be 25% or more after 18 months of breastfeeding. More widely applicable interventions are being developed, such as cleansing of the birth canal and antiretroviral therapy during the breastfeeding period. Keywords Acquired immunodeficiency syndrome/transmission/drug therapy; Disease transmission, Vertical/ prevention and control; Breast feeding/adverse effects; Cesarean section; Anti-HIV agents/pharmacology/adverse effects; Zidovudine/adverse effects; Nevirapine/adverse effects; Risk factors (source: MeSH). Mots cles SIDA/transmission/chimiotherapie; Transmission verticale maladie/prevention et controle; Allaitement au sein/effets indesirables; Cesarienne; Agents anti-HIV/pharmacologie/effets indesirables; Zidovudine/effets indesirables; Nevirapine/effets indesirables; Facteur risque (source: INSERM). Palabras clave Sindrome de inmunodeficiencia adquirida/transmision; Transmision vertical de enfermedad/ prevencion y control; Lactancia materna/efectos adversos; Cesarea; Agentes anti VIH/farmacologia/efectos adversos; Zidovudina/efectos adversos; Nevirapina/efectos adversos; Factores de riesgo (fuente: BIREME). Bulletin of the World Health Organization, 2001, 79: 1138-1144., Introduction Mother-to-child transmission (MTCT) of HIV-1 can occur before, during, and after delivery (1). Transmission is rare during early pregnancy and relatively frequent in late pregnancy and during delivery. Breastfeeding [...]

HIV-infected women in developing countries should be encouraged to use infant formula provided a clean source of water is available to prepare it. This will reduce the risk of the mother transmitting the virus to her baby in breast milk., Context Breastfeeding among women infected with human immunodeficiency virus type 1 (HIV-1) is associated with substantial risk of HIV-1 transmission, but little is known about the morbidity risks associated with formula feeding in infants of HIV-1-infected women in resource-poor settings. Objective To compare morbidity, nutritional status, mortality adjusted for HIV-1 status, and cause of death among formula-fed and breastfed infants of HIV-1-infected women. Design Randomized clinical trial conducted between 1992 and 1998. Setting Four antenatal clinics in Nairobi, Kenya. Participants Of 401 live-born, singleton, or first-born twin infants of randomized HIV-1--seropositive mothers, 371 were included in the analysis of morbidity and mortality. Interventions Mothers were randomly assigned either to use formula (n=186) or to breastfeed (n=185) their infants. Main Outcome Measures Mortality rates, adjusted for HIV-1 infection status; morbidity; and nutritional status during the first 2 years of life. Results Two-year estimated mortality rates among infants were similar in the formula-feeding and breastfeeding arms (20.0% vs 24.4%; hazard ratio [HR], 0.8; 95% confidence interval [Cl], 0.5-1.3), even after adjusting for HIV-1 infection status (HR, 1.1;95% Cl, 0.7-1.7). Infection with HIV-1 was associated with a 9.0-fold increased mortality risk (95% Cl, 5.3-15.3). The incidence of diarrhea during the 2 years of follow-up was similar in formula and breastfeeding arms (155 vs 149 per 100 person-years, respectively). The incidence of pneumonia was identical in the 2 groups (62 per 100 person-years), and there were no significant differences in incidence of other recorded illnesses. Infants in the breastfeeding arm tended to have better nutritional status, significantly so during the first 6 months of life. Conclusions In this randomized clinical trial, infants assigned to be formula fed or breastfed had similar mortality rates and incidence of diarrhea and pneumonia during the first 2 years of life. However, HIV-1--free survival at 2 years was significantly higher in the formula arm. With appropriate education and access to clean water, formula feeding can be a safe alternative to breastfeeding for infants of HIV-1--infected mothers in a resource-poor setting.

HIV-infected pregnant women who decide to have a cesarean delivery may develop health problems following the operation. A cesarean delivery can lower the risk of transmitting the virus to the baby but it can cause fever, hemorrhage, anemia, urinary tract infection and cesarean wound complications.