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Update on successes and challenges regarding mother-to-child transmission of HIV

Paintsil, Elijaha,b; Andiman, Warren Aa,c

doi: 10.1097/MOP.0b013e32831ec353
Infectious diseases and immunization: Edited by Robert S. Baltimore and Hal B. Jenson

Purpose of review There is an unprecedented global commitment to reverse the pediatric HIV epidemic by making prevention of mother-to-child transmission (PMTCT) services accessible in all countries. This review outlines the successes made and the challenges that remain.

Recent findings In resource-rich countries, mother-to-child transmission rates of HIV as low as 1% have been achieved. The efficacy of short-course antiretrovirals for PMTCT in Africa is estimated at 50%. Coinfections with herpes simplex virus type 2, other sexually transmitted infections resulting in genital ulcers, and endemic infectious diseases (e.g., malaria) may increase the risk of mother-to-child transmission of HIV. Vertical transmission of drug-resistant viruses has been reported; the prevalence and effect of transmitted resistant virus on treatment outcomes are under investigation. Obstacles facing PMTCT in resource-limited countries include the lack of healthcare infrastructure, limited manpower, and competing public health priorities with the limited healthcare budget.

Summary Although the birth of an HIV-infected child in a resource-rich country is now a sentinel health event, in most resource-limited countries the birth of an HIV-infected child continues to be the status quo. Comprehensive PMTCT, including antiretroviral treatment for HIV-infected women and children, should be paramount in resource-limited countries.

aDepartments of Pediatrics, USA

bPharmacology, USA

cEpidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA

Correspondence to Elijah Paintsil, Yale University School of Medicine, Departments of Pediatrics and Pharmacology, 333 Cedar Street, New Haven, CT 06520-8064, USA Tel: +1 203 785 7119; fax: +1 203 785 6961; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.