Prevention of perinatal HIV infection: What do we know? Where should future research go?

Major progress has been made in reduction of perinatal HIV transmission in the United States and Europe following the PACTG 076 results using zidovudine (ZDV) for prevention of mother-to-infant HIV transmission. Internationally in the past two years, short-course antiretroviral trials have shown efficacy for both antenatal or intrapartum and postnatal interventions. Trials in Bankok, Thailand, and Cote d'Ivoire demonstrated that antenatal ZDV started at 36 weeks could reduce transmission by 50% among nonbreastfeeding women and about 37% among breastfeeding women. Uganda trial results with one dose of nevirapine given to the mother at the onset of labor and to the newborn resulted in a 47% reduction in transmission when compared to a regimen of ZDV given intrapartum and for 1 week to the newborn. These recent international research findings provide evidence that both shortcourse antenatal/intrapartum and intrapartum/neonatal prophylaxis can effectively reduce perinatal HIV transmission in resource-poor settings. In order to avert the 1600 new infant HIV infections occurring daily, the world community must act to rapidly implement these international perinatal trial results.