Prevention of Mother-to-Child Transmission of HIV Infection

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Abstract
It has been 10 years since a study of perinatal zidovudine regimen showed that it prevented mother-to-child transmission of HIV in 67% of cases [1]. The article from the European Collaborative Study in this issue of Clinical Infectious Diseases [2] summarizes how far we have come over the past 10 years in the developed world. Treatment of HIV-infected pregnant women has increased such that >90% of HIV-infected women receive HAART. The overall rate of mother-to-child transmission of HIV has been dramatically reduced to ⩽1%. The European Collaborative Study [2] confirm that maternal viral load is the key risk factor for mother-to-child transmission of HIV and that the suppression of viral replication through administration of potent combinations of antiretroviral drugs markedly reduces the risk of mother-to-child transmission. In HAART recipients, the only other intervention that significantly reduced mother-to-child transmission of HIV was elective Caesarean section delivery. Although the European Collaborative Study article [2] suggests that elective Caesarean section delivery and receipt of combination antiretroviral therapy may reduce mother-to-child transmission rates more than combination antiretroviral therapy alone, many physicians in the developed world will likely balance the potential risks of the procedure with its potential benefits and reserve this mode of delivery for those women with detectable viral loads (i.e., >50 copies/mL).