American Journal of Obstetrics and Gynecology
Supplement
Reducing the risk of mother-to-child human immunodeficiency virus transmission: past successes, current progress and challenges, and future directions
Section snippets
U.S. Experience
In 1992, at the peak of the U.S. perinatal epidemic, close to 2000 babies in the United States became HIV infected, whereas currently fewer than 200 infants become HIV infected annually (see related article is this issue by McKenna et al). The dramatic success in reducing perinatal HIV transmission across the United States was due in large part to the rapid translation of research trial findings into practice. This was achieved through the combined leadership of the U.S. Public Health Service,
Remaining Gaps and Challenges in Perinatal HIV Prevention Efforts in the US
Despite the dramatic reductions in perinatal HIV and pediatric AIDS seen over the past decade, babies in the United States are still becoming HIV infected. Some of the ongoing issues and program gaps include practitioners who continue to offer HIV testing only to those women they consider at high risk despite CDC recommendations for routine HIV screening for all pregnant women unless they decline; lack of retesting to identify the subset of women who test negative early in pregnancy but then
International Experience in PMTCT
Internationally, following the results of PACTG 076, a number of randomized trials were undertaken to see whether simpler short-course regimens deliverable in resource-limited settings could also significantly reduce the risk of perinatal HIV transmission. The first of these studies’ results were announced in 1998 and included 2 CDC short-course ZDV trials in Thailand and West Africa in which pregnant women were given either oral ZDV or placebo from 36 weeks through labor/delivery. In the
International Trials Aimed at Reducing Transmission among HIV-Infected Women Who Breast-feed
Current international trials are directed at maximally reducing the risk of transmission among breast-feeding HIV-infected women in resource-limited settings in which breast-feeding is the norm and in which not breast-feeding is associated with high infant mortality. A number of different trials are currently underway or about to begin in east, west, and southern Africa. Strategies being assessed include the following: (1) use of 2 antiretrovirals such as short-course zidovudine/lamivudine or
Current Challenges and Program Gaps Internationally
Despite the impressive efficacy of the short-course PMTCT regimens in research clinical trial settings, the translation into public health policy in resource-limited international settings has been disappointingly slow, compared with the rapid widespread implementation seen from the mid-1990s in resource-rich settings. This is due to a variety of factors including weak and crumbling health care infrastructure in some settings, lack of integration of PMTCT programs into maternal child health
Future Directions for PMTCT in the US and Internationally
In the United States, the translation of PMTCT research into practice has been 1 of the major successes in public health efforts to prevent HIV infection. However, lessons from experiences with other diseases such as tuberculosis demonstrate that when successful public health efforts are taken for granted, the gains may be temporary. To sustain achievements, not only do the efforts that led to the declines in perinatal HIV transmission need to continue, but ongoing surveillance of the scope and
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