Prevention of perinatal HIV transmission during pregnancy

Abstract

Transmission of the human immunodeficiency virus (HIV) from mother to child can occur in utero, during labour or after delivery from breastfeeding. The majority of infants are infected during delivery. Maternal HIV-1 plasma viral load at delivery is the most important predictor of vertical transmission. For this reason, efforts to interrupt transmission have focused on the use of antiretroviral therapy. Zidovudine has been shown to reduce significantly vertical HIV transmission when used antepartum and intrapartum by the mother and postpartum by the newborn for 6 weeks. However, zidovudine monotherapy increases the risk of developing zidovudine resistance and may jeopardize the goal of durable viral suppression and allow HIV disease progression in the mother and transmission to the infant. Potent antiretroviral therapy is now recommended for all HIV-infected pregnant women using the same criteria for non-pregnant individuals. If possible, combination antiretroviral regimens should include the use of zidovudine but not at the expense of long-term viral suppression. The use of elective Caesarean section should probably be reserved for women who fail to achieve viral suppression at the time of delivery or if indicated for obstetrical reasons. The practice of breastfeeding has been shown to diminish the long-term efficacy of perinatal antiretroviral therapy. All HIV-infected mothers should avoid breastfeeding the newborn if possible. This review summarizes major prospective and retrospective antiretroviral treatment studies in HIV-infected pregnant women. Pharmacokinetic information as it relates to pregnancy and adverse event profiles of antiretroviral agents are also discussed. The impact of recent advances in the management of HIV infection in pregnancy is discussed with regard to their feasibility in resource-poor countries.

Synthesis and Characterization of DNA Adducts from the HIV Reverse Transcriptase Inhibitor Nevirapine

“…1 H NMR spectra were recorded on a Bruker Avance III 400, a Bruker AV 500b, or a Bruker Avance III 600 (with cryoprobe) spectrometer, operating at 400, 500, and 600 MHz, respectively. 13 C NMR spectra were recorded on a Bruker ARX 400, a Bruker AV 500b, or a Bruker Avance III 600 (with cryoprobe) spectrometer, operating at 100.62, 125.77, and 150.92 MHz, respectively. Chemical shifts are reported in ppm downfield from tetramethylsilane, and coupling constants (J) are reported in Hz; the subscripts ortho, meta, and gem refer to ortho, meta, and geminal couplings, respectively.…”

“…Excitation in 13 C was ensured by a 90°s haped sinc pulse (with one cycle and size shape 1000), covering a 4527.536 Hz bandwidth (centered at 21879.4 Hz); the total spectral width in F2 was 4 ppm (centered at 7 ppm). 13 C resonances are not discriminated whenever small sample quantities precluded the recording of one-dimensional 13 . The reaction mixture was incubated at 37°C for periods ranging from 2 to 7 days and subsequently purified by HPLC.…”

Cost-Effectiveness Analysis of Prophylactic Lamivudine Use in Preventing Vertical Transmission of Hepatitis B Virus Infection

“…It is therefore reasonable to assume that the transmission of HBV to infants could be stopped by reducing the maternal serum viral load through lamivudine use during late pregnancy. [6] Several previous studies have shown the efficacy of using lamivudine in reducing vertical transmission of HBV. [7][8][9] However, evaluation is lacking on the effect of giving prophylactic lamivudine to mothers on long-term consequences in infants such as chronic hepatitis, compensated or decompensated liver cirrhosis and death from liver cirrhosis or liver cancer.…”

Diversity of the Human Immunodeficiency Virus Type 1 (HIV-1) env Sequence after Vertical Transmission in Mother-Child Pairs Infected with HIV-1 Subtype A

“…Antiviral therapy during pregnancy and delivery, combined with elective caesarean section and replacement feeding, has been shown to reduce the incidence of HIV-1 transmission to less than 2% (15). Despite this success and although many factors that affect mother-to-child transmission are known, the exact mechanism remains unclear, and a thorough scientific base to further improve both therapeutic and preventive interventions is missing.…”