Conference Summary [Conference on Global Strategies for the Prevention of HIV Transmission from Mothers to Infants (1997)]

* Some conditions that must be present for an intervention to be cost-effective
in developing world:
= low drug costs
=> high HIV prevalence
Shigh efficacy
= low counseling and testing costs
* Some research has suggested HIV reduces the prevalence of pregnancy in
HIV-infected women by reducing the incidence of conception and increasing
the incidence of fetal loss.
Peripartum Treatment Issues Affecting HIV Transmission from Mothers to
Infants
* There is not yet a consensus on whether pregnant HIV-positive women
should be taking multidrug therapy during pregnancy to treat their own
infection. Some studies suggest combination therapy has significant potential
to prevent mother-to-infant transmission. More research is needed to explore
certain questions. What's the effect of multidrug therapy on the baby in
utero? What are the long-term effects on the child? On the mother? Does the
use of multiple drugs make AZT less effective as a means to prevent
perinatal transmission? How can the goal of treating the mother's infection be
balanced with preventing mother-to-infant transmission?
* More research is needed to examine the mechanisms of mother-to-infant
transmission to determine if Cesarean section births reduce the risk. Some
studies suggest C-sections do reduce the risk, others suggest they make no
difference.
* Nutrition has long been neglected as a factor in HIV infection and
transmission, say some nutrition experts. Common micronutrient deficiencies
in pregnant women in the developing world include vitamin A, iron, folic aid
and zinc. The magnitude of the deficiency problem is higher in HIV-infected
pregnant women. Nutrition deficiencies have been associated with maternal
death, premature births and higher HIV transmission rates. The results of
several nutrition studies are expected in 1998.
* Ongoing studies are looking at numerous issues related to breastfeeding and
HIV transmission. It's unclear during what time period transmission occurs
during breastfeeding. Some research suggests weaning the infant at three
months may be an effective approach. It may be a long enough time to
provide the beneficial nutrients and a short enough time to reduce the risk of
transmission. Long-term breastfeeding has been shown to increase risk,
sometimes sharply. This is a particular problem in many African countries,
where breastfeeding a baby for 24 months is not uncommon. There are still
more questions than answers regarding breastfeeding.

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