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Advances in Preventing Mother to Child Transmission: Current Issues, Future Challenges

This optimistic review, by Marc Bulterys and colleagues at the US Centers for Disease Control and Prevention, summarises recent advances in preventing mother to child transmission (MTCT) of HIV-1. Without any intervention, the risk of MTCT is 15 to 40 per cent, amounting to 1,700 new paediatric infections a day.

In the West, interventions combining elective caesarean section and antiretroviral drugs have reduced this risk to around one per cent. However, such measures require a well-established infrastructure and healthcare system that is expensive and lacking in most of the developing world. The authors state that it is therefore necessary to explore the potential of simpler, less expensive treatment options.

The article includes a detailed account of individual clinical trials on the use of antiretroviral drugs to prevent MTCT, as well as pilot programmes to expand prevention of MTCT in developing countries. It also contains useful tables summarising the current knowledge of factors affecting MTCT, a list of completed phase II/III clinical trials of antiretrovirals (up to February 2002), and outlines a model for implementing a programme preventing MTCT in developing countries.