Mother-to-child Transmission

It is not particularly new information that mother-to-child transmission is one of the most common ways HIV is spread in developing countries, but how have current drug regimens impacted HIV transmission from mother to child in the developed world?

In an early presentation it was pointed out that with the right resources, elimination of pediatric HIV could be a realistic goal. Access to anti-HIV therapy and to clean water and baby formula would be necessary. In most of the U.S., where the necessary resources are available, transmission rates have been reduced to below 3%. When mothers are not on anti-HIV therapy, this rate is approximately 30%.

New drugs, drugs used in combination, and increased access to these drugs, have made it possible for over 50% of pregnant women living with HIV in the U.S. to take HAART (highly active antiretroviral therapy) during their pregnancy. Because of the success of HAART, cesarean section deliveries are no longer being recommended for women with viral loads less than 3000 copies. The success of HAART in lowering transmission was dramatically illustrated in a study by the Pediatric AIDS Clinical Trial Group (PACTG 316). The study was designed to determine the effect of adding a single dose of Viramune (nevirapine), during labor, for women already on anti-HIV medication with a viral load above 3000 copies. The study was stopped early when analysis showed transmission rates below 3% in the arm with women on anti-HIV drugs, without nevirapine.