Mother to child transmission of HIV: What works and how much is enough?

SummaryIn 2012, 3.3 million children were living with HIV (Human Immunodeficiency virus), of whom 260,000 were new infections. Prevention of mother to child transmission is vital in reducing HIV-related child mortality and morbidity. With intervention the risk of transmission can be as low as 1% and without it, as high as 45%. The WHO (World Health Organisation) recommends a programmatic approach to the prevention of perinatal HIV transmission and has withdrawn option A and introduced option B+. This recommends that all HIV positive pregnant and breastfeeding women receive lifelong triple ARV (antiretroviral) from the point of diagnosis. The infant would then receive 4–6 weeks of ART (antiretroviral therapy) (NVP, nevirapine or AZT, Zidovudine) regardless of the feeding method. Where resources are not limited an individualised approach can be adopted. Worldwide, health care needs to be accessible and HIV testing performed in pregnancy and followed up in a robust but socially sensitive way so that treatment can be initiated appropriately. In either setting the risk of transmission is never zero and countries need to decide for themselves what is the most practical and sustainable approach for their setting, so that the maximum impact on maternal and child mortality and morbidity can be achieved.