Advances in therapy for the prevention of HIV transmission from mother to child

ABSTRACT

Introduction: Actually, ~17.8 million women and 1.8 million children (<15 years) are currently infected with the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). Particularly, the majority of pediatric infections (>90%) resulted from ‘HIV mother-to-child transmission’ (MTCT), both in pregnancy, labour, delivery and later by breastfeeding. Due to its high pediatric incidence, MTCT represents a public health concern.

Areas covered: In this review, we focus on available treatments and antiretroviral drugs recommended by the World Health Organization, and the main clinical investigations in antiretroviral pharmacotherapy to prevent the MTCT.

Expert opinion: The MTCT has been improved dramatically in the last few years mainly due to prophylactic perinatal antiretroviral therapy for pregnant women living with HIV. However, there is still a milestone to reach since HIV MTCT remains as a public health challenge associated with MTCT though breastfeeding (post-natal transmission). In this context, different strategies could be employed as an attempt to reduce pediatric HIV infections. One of them involves the improvement of patient adherence to the HIV therapy. One possible solution is the development of novel long-acting formulations for prophylaxis of mothers and children, and a second possible solution is increase the inclusion of mothers and infants in care programs to more effectively prevent the vertical transmission.

KEYWORDS:

• HIV mother-to-child transmission
• antiretroviral pharmacotherapy
• prevention
• pregnancy
• breastfeeding

Article highlights

• Pediatric HIV remains as a public health challenge were the major of these pediatric infections resulted from ‘mother-to-child transmission’ (MTCT).

• Guidelines to promote the prevention of MTCT (PMTCT) (options: A, B and B+) represent a key intervention for the reduction of pediatric HIV infections due to MTCT.

• PMTCT requires ARVs-based therapy for all HIV-infected pregnant women since ARV drugs reduce maternal viral load in blood and genital secretions.

• Despite the benefits of the combined ARVs therapy for both, mother and child, risks associated with the pharmacotherapy should be considered.

• PMTCT during the postnatal period requires pharmacotherapy interventions including children treatment with different ARVs regimens and ARVs prophylaxis to lactating women.

This box summarizes key points contained in the article.

Acknowledgments

Authors thank the Universidad de Buenos Aires (Grant UBACyT 20020130200038BA). Two authors are partially supported by CONICET, Argentina.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was funded by the Universidad de Buenos Aires Grant UBACyT 20020130200038BA.