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Risks and benefits of lifelong antiretroviral treatment for pregnant and breastfeeding women: a review of the evidence for the Option B+ approach

Ahmed, Saeed; Kim, Maria H.; Abrams, Elaine J.

Current Opinion in HIV and AIDS: September 2013 - Volume 8 - Issue 5 - p 474–489
doi: 10.1097/COH.0b013e328363a8f2

Purpose of review Considerable debate has emerged on whether Option B+ (B+), initiation of lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women, is the best approach to achieving elimination of mother-to-child-transmission. However, direct evidence and experience with B+ is limited. We review the current evidence informing the proposed benefits and potential risks of the B+ approach, distinguishing individual health concerns for mother and child from program delivery and public health issues.

Recent findings For mothers and infants, B+ may offer significant benefits for transmission prevention and maternal health. However, several studies raise concerns about the safety of ART exposure to fetuses and infants, as well as adherence challenges for pregnant and breastfeeding mothers. For program delivery and public health, B+ presents distinct advantages in terms of transmission prevention to uninfected partners and increased simplicity potentially improving program feasibility, access, uptake, and retention in care. Despite being more costly in the short-term, B+ will likely be cost effective over time.

Summary This review provides a detailed analysis of risks and benefits of B+. As national programs adopt this approach, it will be critical to carefully assess both short-term and long-term maternal and infant outcomes.

aBaylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, Texas

bICAP, Mailman School of Public Health, Columbia University and College of Physicians & Surgeons, Columbia University, New York, New York, USA

Correspondence to Elaine J. Abrams, MD, ICAP, Mailman School of Public Health, 722 W168th Street, New York, NY 10032, USA. Tel: +1 212 342 0543; e-mail:

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