Mother-to-child HIV-1 transmission: state of the art and implications for public policy.
During the past five years there have been significant advances in the knowledge of the factors that affect mother-to-infant HIV-1 transmission. Diverse interventions have been designed and proven effective in reducing the risk of such transmission. In reviewing the pivotal literature in such respect implications for public policy are also analyzed. Because of the constant evolution of the interventions, the public policies also need constant revisions. The impact of viral load assessment during pregnancy and its relationship to transmission risks is discussed, as well as the effectiveness of elective Caesarean delivery. The latter has both positive and negative aspects which merit consideration. Newer approaches, such as highly active anti retroviral therapies (HAART), which have shown to decrease the AIDS mortality, have also shown zero transmission in small cohorts. Shorter and cheaper interventions are also somewhat effective and are good alternatives to resource poor countries.
Zorrilla
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CD
Obstetrics and Gynecology Department, University of Puerto Rico, Rio Piedras. c_zorrilla@rcmaca.upr.clu.edu
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002585:Cesarean Section; D002986:Clinical Trials as Topic; D005260:Female; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008991:Monitoring, Physiologic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D011640:Public Policy; D012367:RNA, Viral / Q000032:analysis; D012042:Registries; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D019562:Viral Load; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D015215:Zidovudine