Northeast Florida Medicine
Vol. 66, No. 3 2015
53
CME
center for HIV/AIDS Research, Education and Service
(UF CARES), which was also a part of the PACTG, the
PACTG 076 protocol has been implemented since 1994.
By doing so, UF Cares researchers report seeing perinatal
transmission of HIV plummet from approximately 25
percent to less than 1 percent. There have also been years
when there has been no transmission.
However, even in the United States, substantial racial
and ethnic disparities exist in the perinatal transmission of
HIV infection (Figure 1). In the under resourced parts of
the world, perinatal prevention protocols are less available
and difficult to implement. Not surprisingly, most HIV
infected children live in under resourced parts of the
world and most of them do not have access to appropriate
treatment. Although research to find more cost effective
and appropriate MTCT prevention protocols for countries
with fewer resources has shown promise, implementing
these protocols remains a huge challenge.
Preventing and treating MTCT
One of the most effective ways to prevent MTCT is to
diagnose HIV before or early in pregnancy and then treat
the HIV infected mother. It is also critical to provide in-
trapartum antiretroviral therapy and provide the newborn
with antiretroviral medications after birth. In addition,
breast feeding should be avoided. Major challenges exist
in each of these effective elements in preventing MTCT.
As Figure 2 displays, many pregnant women do not re-
ceive antiretroviral therapy. Although avoidance of breast
feeding in Africa decreased the transmission of perinatal
HIV infection, mortality increased in the breast feed
avoidance group.
3
This is most likely due to poor hygiene
and lack of clean and safe water. Consequently, WHO
does not recommend avoidance of breast feeding in the
Figure 1:
Rates (per 100,000 Live Births) of Diagnosed
Perinatally Acquired HIV Infections, by Year of Birth and
Race/Ethnicity,a 2007-2009 – 46 States/ Source: Centers
for Disease Control and Prevention
Figure 2:
Number of pregnant women living with HIV in low- and middle-income countries and the number
and percentage of those women receiving ARV drugs for PMTCT of HIV, 2005-2013
