HIV in mothers and children

There has been a dramatic fall in the rate of mother-to-child transmissions (MTCTs) of human immunodeficiency virus (HIV) since the introduction of universal HIV testing in antenatal clinics in the UK. Currently in the UK, less than 1% of infants born to women found to be HIV-positive before delivery will become infected. Maternal anti-retroviral therapy (ART) is commenced in accordance with the mother's immune status and viral load, with the aim of achieving an undetectable viral load by delivery. Replacement feeding effectively eliminates postnatal MTCT but, where this is not safe, studies have shown that continuing ART for mothers or their infants until after breastfeeding has ceased can further reduce transmission. Access to effective ART strategies in the prevention of MTCT in low- and middle-income countries has improved but is still only approximately 50%. ART is now initiated earlier in children and has significantly reduced mortality and morbidity with perinatally HIV-infected children growing up and transitioning into adult care. Unfortunately, there are still serious difficulties surrounding access to paediatric formulations and adequate diagnostics for children in resource-poor settings. Hypervigilance for the potential long-term toxicities of ART in children is particularly important, as treatment initiated at a young age is currently a lifelong commitment.