Drug Therapy to Prevent Mother-to-Child Transmission of HIV
In 1994, research demonstrated that zidovudine, an RT inhibitor drug administered to both HIV-infected mothers and their newborns, reduced perinatal mother-to – child transmission (MTCT) by two thirds (Connor et al., 1994). In August 1994 the U. S. Public Health Service recommended zidovudine to reduce perinatal MTCT of HIV. Since 1994 the number of infants infected through MTCT has been almost
eliminated in the United States and Europe via widespread implementation of medical interventions (Lallemant et al., 2011). Sadly, this is not the case in Africa, where MTCT of HIV is still rampant and a majority of HIV-infected children do not receive antiretroviral therapy and half die before they reach age 2 (Lallemant et al., 2011).
The limited health systems of most African nations have stimulated a search for a less costly, more practical, and more effective short-course antiretroviral regimen. Studies in South Africa and Uganda found that infants who were provided with either (1) a single dose of the RT inhibitor drug nevirapine within 24 hours of birth or (2) a short-course regimen with this drug experienced excellent protection from HIV infection (Altman, 2002; Moodley et al., 2003). Because single-dose or short-course nevirapine therapy is dramatically less costly than the longer and more complex zidovudine regimen, many countries with limited resources are now utilizing this drug to reduce MTCT of HIV (Spensley et al., 2009).
Preventing perinatal MTCT does not eliminate the possibility of later transmission of the virus from a mother to a child through breast-feeding (Osborn, 2008). In subSaharan African countries, breast-feeding is usually essential for infant survival, because alternatives to breast milk are generally nonexistent or unaffordable. It is estimated that about 16% of untreated infants, whose mothers are HIV infected, will acquire MTCT of HIV if breast-feeding continues into the second year of life (Kumwenda et al., 2008). A recent investigation in Botswana revealed that HAART regimens were effective in suppressing viral loads during pregnancy and later during breast-feeding. The HAART regimen, commenced no later than the 34th week of gestation and continued through up to 6 months of breast-feeding, achieved a 1.1% rate of MTCT at 6 months, the lowest recorded in a breast-feeding population (Shapiro et al., 2010).
Health officials also hope that presenting alternatives to breast-feeding, such as breast – milk substitutes or early weaning, will help reduce the transmission of HIV through breast milk. Unfortunately, breast-milk transmission continues "in vast areas in which alternatives to breast-feeding are unavailable, unsafe, or both" (Osborn, 2008, p. 582).