HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.): SECTION A : HIV IN PREGNANCY: Appropriate interventions to reduce mother-to-child transmission: Immune therapy

HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.)

SECTION A : HIV IN PREGNANCY

Appropriate interventions to reduce mother-to-child transmission

		(introduction...)
		Antiretroviral therapy
		Immune therapy
		Nutritional interventions
		Mode of delivery
		Vaginal cleansing
		Modification of infant feeding practice

Immune therapy

Both passive immunization with hyper-immune HIV immunoglobulin (HIVIG) and active immunization with HIV vaccines have been proposed as alternative mechanisms to prevent mother-to-child transmission^111,113,292.

Passive immunization with intravenous HIV immunoglobulin has been investigated. A trial [ACTG185] of the use of HIVIG, in a cohort of women, who all received ZDV, was stopped after an interim analysis showed low transmission rates in both the study and control group. The transmission risk for the HIVIG Group was 4.1% (95% confidence interval 1.5%-6.7%) and the transmission risk for IVIG was 6.0% (95% confidence interval 2.8%-9.1%)²⁹³. Very large numbers would have been required to show any significant reduction in these rates attributable to the HIVIG use. Another study is ongoing in Uganda in ZDV na patients. Concerns remain about the costs and the donor sources for these products, standardized preparations and optimal delivery time.

Active immunization could possibly induce immunity in the mother and in the fetus by passive transfer of antibodies^111,294. Effective vaccines have not yet been identified, although several Phase I/II trials are in progress¹¹³.