Preventing mother-to-child transmission of HIV: practical strategies for developing countries

The HIV pandemic has greatly affected women of childbearing age in developing countries and, thus, their offspring, through mother-to-child transmission (MTCT) of the virus. Scientific advances, most of them established by randomized clinical trials, have recently led to the development of practical strategies aiming to reduce the public health burden of MTCT of HIV. These advances came first in non-breast-feeding populations, for example, in Thailand and, more recently, in African populations, where breast-feeding remains the predominant mode of infant feeding. This article reviews major accomplishments in this area, outlines practical issues for program implementation, and suggests future research needs. Short-course zidovudine and short-course nevirapine in the peripartum period currently represent 2 valid options to reduce MTCT of HIV in developing countries if appropriate prenatal, obstetrical, and postnatal care is provided and if alternatives to breast-feeding are considered according to the local situation and the mother's individual decision.