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


RESULTS
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.


CONCLUSIONS
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.
Paintsil
Elijah
E
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA. Elijah.paintsil@yale.edu
Andiman
Warren A
WA
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D019049:Developed Countries; D003906:Developing Countries; D024882:Drug Resistance, Viral; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009034:Mother-Child Relations; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D011314:Preventive Health Services / Q000379:methods / Q000458:organization & administration; D012307:Risk Factors; D016896:Treatment Outcome
D044966:Anti-Retroviral Agents