Mother-to-child transmission of HIV: positive impacts

Mother-to-child-transmission (MTCT) of HIV remains the major mode of paediatric HIV infection. Advances in the prevention of MTCT over the past decade and a half represent a major public health achievement. Strategies to prevent MTCT are now the standard of care for countries rich enough to afford the interventions. As such, perinatally acquired HIV in countries like the USA and Europe is now a rare event. With clearly documented declines in MTCT rates in resource rich countries, the focus is shifting towards any downsides of these strategies in pregnant women and for fetuses exposed in utero to antiretroviral (ARV) drugs and to infants postnatally. Cumulative evidence still supports the benefits of these strategies in preventing MCTC of HIV, with continued benefits for HIV pregnant women and their infants, and with minimal adverse outcomes. Knowledge of HIV infection status in pregnancy is critical for identifying the need for MTCT prevention. However, antenatal testing rates to identify HIV infected women is variable and an area that warrants attention. The overwhelming challenge in the 21st century is up scaling the availability of MTCT interventions in resource poor areas where more than 90% of the world's HIV infected children now reside, and to develop optimal MTCT regimens that can be practically adopted in these settings.