Mothers and babies: widening the HIV safety net

A national health policy of exclusive breastfeeding is finally imminent while routine re-testing of initially HIV-negative pregnant women at 32 weeks could soon become standard practice. These two simple measures would boost the already impressive gains in prevention of HIV transmission from mothers to infants (PMTCT) -- a major highlight of the fifth South African AIDS conference in Durban from 7 to 10 June this year. National surveys presented at the conference showed that the MTCT rate among babies 4 - 6 weeks old has dropped to 3.5%, potentially saving some 67 000 infants from HIV infection. This is a dramatic acceleration from the 8.8% MTCT rate under the previous regime of a single dose of nevirapine to mothers and their newborns. The impressive gains are almost exclusively due to a much-awaited policy change last April when all HIV-positive pregnant women began receiving AZT from 14 weeks of pregnancy (instead of at 28 weeks) and triple therapy (nevirapine, tenofovir and 3TC) during labour (when most infections take place). Those women with CD4 cell counts below 350 were also put onto triple therapy within 2 weeks of getting their CD4 cell results and all HIV-positive newborns were given nevirapine syrup for as long as their mothers were breastfeeding them (or for 6 weeks if not breastfed), regardless of CD4 cell count. Together these measures have put South Africa on track to meet this part of its 2007 - 2011 National Strategic Plan on HIV/AIDS (i.e. reducing MTCT to less than 5%), with the latest policy changes likely to edge the country even closer towards European and United States MTCT rates, where paediatric HIV infections are 1% or less.