Fifth International Congress Drug Therapy in HIV Infection 22-26 October, 2000 Glasgow, UK

Interrupting maternal-foetal transmission: State-of-the-art review

H. Coovadia
Department of Paediatrics and Child Health, University of Natal Medical School, Durban, South Africa

Int Cong Drug Therapy HIV 2000 Oct 22-26;5:Abstract No.
AIDS 2000, Oct 22-26;14(Suppl. 4);S1

The means to interrupt transmission of HIV from mothers to their infants have been identified and expanded over the past seven years. The major studies on the use of antiretrovirals (ARVs) to reduce mother-to-child transmission (MTCT), carried out in both industrialised and developing countries, have reported their medium term (between one to two years) results. The most important next steps are to move from research to programme implementation to national coverage. Policy makers now have available a range of options from which to choose a regimen most suited to their populations and budgets. Long course (ARVs) antepartum, intrapartum, postpartum) in non-breastfeeding women are the most effective (68% reduction in MTCT), shorter courses in such groups are less effective (50% reduction). The impact of ARVs on MTCT in breastfeeding communities is lower than in non-breastfeeding communities: longer courses are generally more effective than shorter courses, the latter resulting in reductions of about 40% to 50% within the first few months of infancy. These early benefits are reduced with continued breastfeeding and the attrition rate appears to vary according to the drug used and the population studied. A single dose of nevirapine (NVP) to the mother (during delivery) and to the newborn promises to be the simplest and most cost-effective regimen with sustained beneficial effect up to one year. Medium term data on the adverse affects of foetal and neonatal exposure to AZT, and short term reports on NVP, are reassuring. Breastfeeding remains the norm in developing countries, even in HIV affected women; the objective is therefore to make breastfeeding safe. Exclusive breastfeeding for six months with rapid weaning may be one option; other measures (ARVs, prevention of mastitis, vaccines) are being investigated. Elective caesarian section reduces MTCT by 50%; when combined with ARVs this figure goes up to 87%. Non-antiretroviral interventions (Vitamin A prophylaxis, and cervico-vaginal plus newborn cleansing with 0.25% chlorhexidine) improve pregnancy outcomes but do not influence MTCT. Treatment of chorioamnionitis to reduce intrauterine transmission is under study.

Presenting author: H. Coovadia

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2000-10-22

Originally published in AIDS Volume 14, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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