Institut de Recerca de la SIDA - IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Crta. de Canyet s/n, Planta 2a, 08916 Badalona, Catalonia, Spain; HIV Unit, Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Catalonia, Spain; Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States; Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Atlanta Veterans Affairs Medical Center, Atlanta, GA, United States; Brigham and Women's Hospital, Boston, MA, United States; Harvard School of Public Health, Boston, MA, United States; Botswana Harvard School of Public Health AIDS Initiative Partnership, Gaborone, Botswana; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, United States; Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, United States
Paredes, R., Institut de Recerca de la SIDA - IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Crta. de Canyet s/n, Planta 2a, 08916 Badalona, Catalonia, Spain, HIV Unit, Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Catalonia, Spain, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Marconi, V.C., Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States, Atlanta Veterans Affairs Medical Center, Atlanta, GA, United States; Lockman, S., Brigham and Women's Hospital, Boston, MA, United States, Harvard School of Public Health, Boston, MA, United States, Botswana Harvard School of Public Health AIDS Initiative Partnership, Gaborone, Botswana; Abrams, E.J., Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, United States; Kuhn, L., Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States, Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, United States
The global community has committed itself to eliminating new pediatric HIV infections by 2015 and improving maternal, newborn, and child health and survival in the context of HIV. Such objectives require regimens to prevent mother-to-child transmission (pMTCT) which, while being highly efficacious, protect the efficacy of future first-line antiretroviral therapy (ART). Major obstacles to eliminating vertical transmissions globally include low rates of adherence to ART and non-completion of the 'pMTCT cascade' due to programmatic and structural challenges faced by healthcare systems in low-income countries. Providing all pregnant women with lifelong ART regardless of CD4 count/disease stage (Option B+) could be the most effective option to prevent both HIV transmission and resistance, assuming adherence is successfully maintained. This strategy is more likely to achieve sustained undetectable HIV viremia, does not involve ART interruptions, is simpler to implement, and is cost-effective. Where Option B+ is not available, options A (short course zidovudine with single-dose nevirapine and an ARV "tail") and B (combination ART during pregnancy and breastfeeding, with ART cessation after weaning in women not qualifying for ART for their own health) are also efficacious, highly cost-effective and associated with infrequent resistance selection if taken properly. © The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
