Prevention and treatment of perinatal HIV-1 infection in the developing world

Measures to reduce mother-to-child transmission of HIV-1 are discussed according to the presumed timing of transmission. Long course antiretrovirals can substantially decrease intrauterine transmission. Antiretrovirals and caesarean section reduce vertical transmission by preventing intrapartum transmission; but caesarean section is unsuitable for most developing countries. Short and very short course antiretrovirals have an efficacy rate of about 50% in non-breastfeeding populations compared with just under 40% at 6 months and between 23 and 30% at 15-24 months in breastfeeding women. The latter is due to the fact that postnatal transmission occurs as long as breastfeeding continues. Breastfeeding accounts for a third to a half of overall transmission. Exclusive rather than mixed breastfeeding appears to diminish the risk of transmission, and HIV-infected women who choose to breastfeed should be advised to give breastmilk exclusively for a maximum of 5-6 months.