AEGiS-Glasgow [PL4.1] The challenges for controlling maternal-child transmission in resource poor settings

Seventh International Congress on Drug Therapy in HIV Infection

Glasgow, UK - 14-17 November 2004

[PL4.1] The challenges for controlling maternal-child transmission in resource poor settings

Int Cong Drug Therapy HIV 2004 Nov 14-18;7:Abstract No. PL4.1

Glenda E. Gray
University of Witwatersrand, South Africa

Mother-to-child-transmission of HIV (MTCT) can occur before, during and after delivery. Most of transmission occurs during late pregnancy and delivery, and in resource poor settings, breastfeeding contributes substantially to the overall risk. Other risk factors for MTCT include advanced maternal disease, prematurity; prolonged rupture of membranes and vaginal delivery. Current approaches to interventions to reduce MTCT target the peri-partum period and the more effective interventions include the reduction of maternal viral load through antiretroviral therapy (ART); avoidance of exposure to maternal secretions through elective caesarean delivery, and avoidance of breastfeeding.

Zidovudine monotherapy initiated in the antenatal period (16-36weeks), given intrapartum and in varying periods to the mother and/or infant post-natally has reduced transmission by between 50-67%. In addition, the demonstration that single-dose Nevirapine (sd-NVP) given to the mother during labour and her infant post-natally halved the risk of transmission, represented a major breakthrough for preventing paediatric HIV infections in poor resourced settings. The addition of sd-NVP to antenatal/intrapartum/ post-partum ZDV regimens in both Thailand and Africa have driven transmission down to rates seen previously only in the developed world.

There is a widening gulf between resource-rich and resource-poor countries: In developed countries, the focus is on the possible extremely rare side effects of exposure to ART, and minor adaptations to regimens; in developing countries, preventing peri-partum MTCT through access to NVP monotherapy or ZDV/NVP combinations remains the current goal. In the light of increasing access to ART in the developing world, recent data showing the detection of unacceptably high levels of maternal and infant non-nucleoside reverse transcriptase inhibitor resistance following sd-NVP is of great concern to policy makers in the developing world.

SESSION 4: RESOURCE-POOR SETTINGS [IAS SESSION]

2004-11-14
PL4.1

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