VERTICAL TRANSMISSION: Experts Recommend Expanded Use of Antiretrovirals for Prevention
Experts on mother-to-infant transmission of HIV have issued recommendations suggesting that the proven safety and effectiveness of antiretroviral regimens used to prevent HIV transmission from mother to infant "warrant their use beyond pilot projects and research settings," according to a UNAIDS press release. The WHO Technical Consultation, held Oct. 11-13 in Geneva on behalf of the UNAIDS/UNICEF/UNFPA/WHO InterAgency Task Team on the Prevention of Mother-to-Child Transmission of HIV, concluded that prevention methods should be included in the "minimum standard package of care for HIV-positive women and their children," and that "there is no justification to restrict use of any of these regimens" to research. "A number of available regimens are known to be effective and safe. ... The choice should be determined according to local circumstances on the grounds of costs and practicality, particularly as related to the availability and quality of antenatal care," Dr. Winnie Mpanju-Shumbusho, director of the HIV/AIDS/STI Initiative of WHO, said. Several preventive regimens have been tested, the most complex of which includes administering doses of zidovudine to pregnant women before and during birth and to the infant immediately following birth. The simplest regimen consists of one dose of nevirapine during labor and one dose to the infant. Previous recommendations warned against the widespread use of nevirapine to prevent mother-to-infant transmission due to concerns of the development of drug-resistant strains of HIV. However, the experts concluded that the benefits of preventing transmission outweigh the "theoretical concerns" linked to development of drug resistance. Prevention programs should also include testing and counseling services, support for mothers and infants and options for infant feeding, the task team concluded, noting that women who choose to breastfeed are urged to do so exclusively until a switch to an "alternative form" of feeding is possible (UNAIDS release, 10/25).This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.