Prevention of mother-child HIV transmission: progress and problems

(1) Since 1994, zidovudine administration to pregnant women and their newborns has been the reference prophylaxis for mother-child HIV transmission. (2) Three trials done in Thailand and Africa show that zidovudine therapy during the last few weeks of pregnancy reduces the risk of transmission, especially when breast-feeding is avoided. (3) A retrospective study done in the United States suggests that even very late zidovudine administration may benefit the mother and/or her child. (4) A trial done in Uganda suggests that a single dose of nevirapine has better preventive activity than a very short course of zidovudine in women who breastfeed. (5) There are very few data on the risk-benefit ratio of multidrug antiretroviral regimens in pregnant women. (6) Eight cases of mitochondrial involvement have been diagnosed in France in children exposed to zidovudine or to the zidovudine + lamivudine combination. These cases call for long-term close monitoring of children exposed to antiretroviral drugs in utero. To limit the duration of fetal exposure, the third trimester of pregnancy is now recommended as the safest time to start antiretroviral prophylaxis. (7) Despite a randomised trial and a meta-analysis suggesting that elective caesarean section prevents mother-child HIV transmission, the value of such surgery remains controversial.