Background

Transmission of HIV from mother-to-child can occur during pregnancy and delivery, as well as through breastfeeding. Such mother-to-child transmission of HIV represents a major cause of morbidity and mortality among young children, particularly in developing countries with a high prevalence of HIV infection. Interventions to prevent mother-to-child transmission of HIV, including recent breakthroughs in antiretroviral therapy, offer immediate opportunities to: (i) save children's lives; (ii) reduce the impact of HIV on families and communities; and (iii) strengthen maternal and child health services.

In addition to the long regimen (ACTG 076) proven effective in 1994, a CDC-sponsored trial in Thailand demonstrated in February 1998 that the use of a shorter zidovudine regimen, which is more feasible and affordable in developing countries, is also effective. This shorter regimen, involving the administration of zidovudine to mothers during the last four weeks of pregnancy and during delivery, has been shown to reduce mother to child transmission by half among women who do not breastfeed. An integrated prevention programme which combines the use of this regimen and the use of safe alternatives to breastfeeding would be effective in reducing mother to child transmission of HIV among breastfeeding populations.

Recent cost-effectiveness data suggest that in many developing countries this intervention is comparable to other public health interventions. It is clear that there is an urgent need to begin to implement such interventions to reduce the transmission of HIV from mother to child.