STRATEGY FOR CONTROL OF HIV AND AIDS

STRATEGY FOR CONTROL OF HIV AND AIDS

STRATEGY FOR CONTROL OF HIV AND AIDS

Early clinical trials showed that zidovudine monotherapygiven to mothers from the second trimester up to andincluding the intrapartum period, together with 6 weeksof zidovudine therapy given to the infant, results in anapproximately 70% reduction in transmission rates. Subsequentstudies have shown a relationship between thelevel of maternal plasma viral load on treatment at birthand the risk of transmission. In the developed world it isnow common practice to initiate triple combination antiretroviraltherapy to achieve and sustain maximumsuppression of maternal plasma viral load levels duringpregnancy and through the intrapartum period. The avoidanceof breastfeeding is essential to sustain this reductionin risk. The implementation of these measures, however, isonly possible if both the mother and her physician areaware that she is seropositive during pregnancy. HIV antibodytesting should routinely be offered to all pregnantwomen, irrespective of the perception of risk.In the developing world vertical transmission is a majorproblem and complex triple combination therapies aretoo costly. Recent studies have investigated simpler andshorter-course treatments. A single dose of the nonnucleosidereverse transcriptase inhibitor nevirapine, givento the mother at the onset of labour and to the infant aged48 hours, has been shown to reduce perinatal transmissionby approximately 50%, compared to a short course ofzidovudine given to the mother during labour and postnatallyto the infant for 7 days. Peripartum therapeutic interventionwill have no effect on intrauterine transmission.The reduction in transmission rates in infants at 6 weeks islikely to be lost in a breastfeeding population at 2 years, asa result of continued postnatal transmission. The widescaleimplementation of an effective therapeutic intervention toprevent perinatal transmission in the developing world isa challenge that remains to be met.The risk of occupational transmission of HIV as a resultof needle-stick injuries has been estimated to be 0.3%.Although there is no substantial evidence of clinical efficacy,and based largely on biological rationale, it is recommendedthat health-care professionals who sustain asignificant exposure to a bodily fluid from an HIV-infectedperson should take a triple combination regimen as postexposureprophylaxis for 4 weeks after the incident. Prophylaxisshould be started as soon as possible after theincidence, preferably within 1-2 hours. The relative benefitof such a regimen remains uncertain. Postexposure prophylaxishas also been considered after sexual exposure,but in the absence of any data to support a relative benefitno specific guidelines have been recommended.

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