Which advancements have led to a significant decrease in perinatal HIV transmission risk?

Updated: Apr 02, 2019
  • Author: Ashley T Peterson, MD; Chief Editor: Ronald M Ramus, MD  more...
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Answer

The reduction in mother-to-child transmission of human immunodeficiency virus (HIV) is regarded as one of the most effective public health initiatives in the United States. In the absence of treatment, the risk of vertical transmission of HIV is as high as 25-30%. With the implementation of HIV testing, counseling, antiretroviral medication, delivery by cesarean section prior to onset of labor, and discouraging breastfeeding, the mother-to-infant transmission has decreased to less than 2% in the United States.

Before the current treatment era, approximately 2000 babies were infected with HIV each year in the United States alone. [1] That figure now stands at less than 200 infants per year since 2010 (there were 86 perinatal transmissions in the US in 2015).

The rapid clinical implementation of research findings directed toward decreasing perinatal transmission is credited as the key to this accomplishment. In 1994, the Pediatric AIDS Clinical Trials Group (PACTG) protocol 076 demonstrated that the administration of zidovudine during pregnancy and labor and then to the newborn decreased the risk of perinatal transmission of HIV by 68%, from 25.5% to 8.3%. [2] In the late 1990s, the combined use of 3 or more antiretroviral medications was found to be highly successful at suppressing viral replication.


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