Recent advances in prevention of mother to child (PMTCT)of HIV.

Philipa Musoke,
Department of Paediatrics and Child Health, Makerere University

In Africa alone, over 1600 infants become infected with human immunodeficiency virus (HIV) each day despite the advances in prevention of mother to child transmission (PMTCT). WHO recommends the 4 pronged approach to PMTCT that includes primary prevention of HIV,
prevention of unintended pregnancies in HIV infected women, PMTCT and care and support for HIV infected women, infants and families. The complete PMTCT package includes comprehensive antenatal (ANC) care, modified obstetric practices, antiretroviral therapy and infant feeding counseling and support. This editorial will focus mainly on the advances made in antiretroviral regimens for PMTCT.

The first major breakthrough for PMTCT was in 1994 when US/ French researchers proved that zidovudine (AZT) in pregnancy could reduce vertical transmission. The ACTG 076 study demonstrated that zidovudine (AZT) starting at 14 weeks gestation, intravenous in labor and for 6 weeks to the infant postnatally reduced vertical transmission by 67%. Subsequently shorter regimens using AZT from 36 weeks gestation with or without dosing of the infant demonstrated 50% reduction in HIV transmission albeit less in breastfeeding populations

The most simple and feasible regimen to date is the HIVNET 012 regimen where mothers received a single 200mg tablet of nevirapine (NVP) at the onset of labor and the infant’s received a single 2mg/kg/dose dose of NVP syrup within 72 hours of delivery. This regimen
demonstrated a 47% reduction in HIV transmission at 6 weeks of age. Recent data from Thailand have shown a further and significant reduction in transmission when single dose NVP to the mother and her infant was added to the standard AZT regimen starting at 28 weeks gestation.