Current standards for HIV vertical transmission prevention

Vertical transmission of HIV to newborns and infants during pregnancy, labour and delivery, and breastfeeding ranges from 15 % to 45 % without intervention. The most important risk factor for transmission is a high maternal viral load. Prevention guidelines for low- and middle-income (high-burden) countries differ from those for high-income (lower-burden) settings, with a key differences in provision of caesarean section, post delivery antiretroviral care of the baby and infant feeding practice. This review will focus on a comprehensive approach to the elimination of paediatric HIV. We will discuss aspects of prevention of HIV and the current standards of care in the prevention of vertical transmission. We highlight the differences between well-resourced and lower-resourced settings including approaches to caesarean section and breastfeeding and infant prophylaxis. We also touch on the potential of emerging strategies to further reduce vertical transmission of HIV. Lastly, despite progress in prevention, challenges persist, particularly in sub-Saharan Africa due to structural health system gaps and loss to care. The recent reduction in donor funding threatens the progress made in transmission prevention.