Human immunodeficiency virus type 1 mother-to-child transmission and prevention: successes and controversies

Cavarelli M., Scarlatti G (Unit of Viral Evolution and Transmission, DITID, San Raffaele Scientific Institute). Human immunodeficiency virus type 1 mother-to-child transmission and prevention: successes and controversies (Symposium). J Intern Med2011; 270: 561-579. The World Health Organization (WHO) and United Nations Programme on HIV/AIDS (UNAIDS) estimated that an additional 370 000 new human immunodeficiency virus type 1 (HIV-1) infections occurred in children in 2009, mainly through mother-to-child transmission (MTCT). Intrapartum transmission contributes to approximately 20-25% of infections, in utero transmission to 5-10% and postnatal transmission to an additional 10-15% of cases. MTCT accounts for only a few hundred infected newborns in those countries in which services are established for voluntary counselling and testing of pregnant women, and a supply of antiretroviral drugs is available throughout pregnancy with recommendations for elective Caesarean section and avoidance of breastfeeding. The single-dose nevirapine regimen has provided the momentum to initiate MTCT programmes in many resource-limited countries; however, regimens using a combination of antiretroviral drugs are needed also to effectively reduce transmission via breastfeeding.