Treatment of HIV-infected mothers and infants

  Recently, Professor Katherine Luzuriaga and others at the Medical College of Massachusetts interpreted the latest guidelines for the prevention and treatment of HIV infection in children, with the aim of helping clinicians to quickly and accurately treat the disease.  Acquired immunodeficiency syndrome (AIDS) in children was first identified in 1982 and the first adult patient was reported 18 months later. Most children acquire human immunodeficiency virus (HIV) infection from the mother-to-child transmission route, including transmission through the placenta, during delivery, or through breastfeeding.  The viral load of the mother is an independent risk factor for transmission of the virus, and transmission rates decrease substantially when viral replication is sufficiently suppressed. Until effective prevention measures are in place, the rate of mother-to-child transmission is 15-25% for formula-fed infants and 25-40% for breast-fed infants.  Interruption of mother-to-child transmission Recommended antiretroviral treatment regimen for pregnant and lactating women: Lifetime antiretroviral therapy for diagnosed HIV infection, regardless of CD 4+ cell count level. Starting antiretroviral therapy before pregnancy and continuing throughout pregnancy can significantly reduce the rate of mother-to-child transmission.  The Commission on Health and Services for People Living with HIV recommends two nucleoside ARV inhibitors + ritonavir or daraviravir-ritonavir or efavirenz or raltegravir for pregnant women in the United States.  WHO recommends tenofovir + lamivudine or emtricitabine + efavirenz for antiretroviral regimens for pregnant and lactating women in resource-poor countries.  To control neonatal HIV infection, in addition to antiretroviral regimens, it is important to reduce new HIV infections in women of childbearing age and to use contraception.  Early treatment reduces infant and child mortality?  WHO and U.S. guidelines recommend early diagnosis and immediate initiation of antiretroviral therapy for infants and children under 12 months of age with HIV infection.  Lifelong antiretroviral therapy for all HIV-infected women during pregnancy significantly improves maternal health and survival and significantly reduces perinatal HIV infection in newborns, but also exposes the fetus to antiretroviral drugs and increases the rate of preterm birth and other adverse pregnancy outcomes. Further studies are needed to optimize antiretroviral regimens to increase safety.