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Elimination of perinatal HIV infection in the USA and other high-income countries: achievements and challenges

Nesheim, Steven; Harris, Lauren Fitz; Lampe, Margaret

Current Opinion in HIV and AIDS: September 2013 - Volume 8 - Issue 5 - p 447–456
doi: 10.1097/COH.0b013e3283636ccb
PREVENTION OF MOTHER TO CHILD TRANSMISSION: Edited by Lynne M. Mofenson

Purpose of review To describe progress and challenges to elimination of mother-to-child HIV transmission (EMCT) in high-income countries.

Recent findings Despite ongoing declines in the number of perinatally HIV-infected infants in most high-income countries, the number of HIV-infected women delivering may be increasing, accompanied by apparent changes in this population, including higher percentages with antiretroviral ‘pretreatment’ (with possible antiretroviral resistance), other coinfections, mental health diagnoses, and recent immigration. The impact of antiretroviral resistance on mother-to-child transmission is yet to be defined. A substantial minority of infant HIV acquisitions occurs in the context of maternal acute HIV infection during pregnancy. Some infant infections occur after pregnancy, for example, by premastication of food, or breastfeeding (perhaps by an uninfected woman who acquires HIV while breastfeeding).

Summary The issues of EMCT are largely those of providing proper care for HIV-infected women. Use of combination ART by increasing proportions of the infected population may function as a structural intervention important to achieving this goal. Providers and public health systems need to be alert for HIV-serodiscordant couples in which the woman is uninfected and for changes in the population of HIV-infected pregnant women. Accurate data about HIV-exposed pregnancies are vital to monitor progress toward EMCT.

aEpidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, Sexually Transmitted Disease and Tuberculosis Prevention, Centers for Disease Control and Prevention

bICF International, Atlanta, USA

Correspondence to Steven Nesheim, MD, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-45, Atlanta, GA 30333, USA. Tel: +1 404 639 8273; fax: +1 404 639 6127; e-mail: sxn9@cdc.gov

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