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Global elimination of new perinatal infections possible by 2015
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ATLANTA — Elimination of new perinatal infections in the next 2 years is feasible, but will require radical change in overall health care and infrastructure, in addition to antiretroviral drugs, according to Lynne M. Mofenson, MD, who delivered the 18th Bernard Fields Lecture and 7th N’Galy-Mann Lecture at the 20th Annual CROI meeting here.
“With treatment scale-up in resource-limited countries, it is now feasible to provide combination [antiretroviral] regimens to HIV-positive pregnant women during pregnancy, breast-feeding and potentially for life, and we can now discuss virtual elimination of new perinatal infections globally by 2015 (mother-to-child transmission <5% and <40,000 annual infections), leading the way toward demonstrating the feasibility of a vision of an AIDS-free world,” Mofenson said. “However, this challenging goal will require not only [antiretroviral] drugs but radical change in health care and system infrastructure.”
Lynne M. Mofenson
Mofenson, chief of the Pediatric, Adolescent, and Maternal AIDS Branch at the NIH’s National Institute of Child Health and Human Development, said in the 30 years since mother-to-child transmission (MTCT) of HIV was reported, there has been a switch from an accelerating epidemic of HIV infection in children to the potential elimination of perinatal infections.
Early in the HIV epidemic, Mofenson said interventions for women with HIV were limited to avoidance of invasive procedures during pregnancy and recommendation not to breast-feed. Epidemiologic studies of women with HIV have shown advanced maternal HIV disease and high viral load increased MTCT risk.
“Once zidovudine (AZT; Retrovir, ViiV Healthcare) was approved for adult treatment, pediatric and obstetric researchers moved quickly to propose using AZT during pregnancy to reduce MTCT; however, giving a potentially toxic drug to pregnant women was highly controversial,” Mofenson said. “In 1994, results of PACTG 076 provided the first demonstration of treatment as prevention and efficacy of pre-exposure prophylaxis.”
Soon after, a public health effort was under way, with a collaboration of multiple US government agencies, professional and advocacy organizations. From this, rapid approval, financing and implementation of the intervention, accompanied by recommendations for universal HIV testing in pregnancy, legislation and substantial investment of resources, provider training and social marketing were in place, Mofenson said.
Within 2 years, MTCT of HIV in the United States declined from 25% to 5% to 8%; the most recent data indicate the annual rate of MTCT of HIV has decreased more than 90% from 1991, to a rate of less than 2%.
Globally, however, more than 1,000 children are infected with HIV each day; most of these occur in sub-Saharan Africa. Since 2008, antiretroviral prophylaxis of the breast-feeding infant or lactating mother has been used to significantly reduce postnatal MTCT and has allowed breast-feeding to continue safely in this setting.
For more information:
Mofenson LM. Paper #15. Presented at: 2013 Annual CROI Meeting; March 3-6, 2013; Atlanta.
Disclosure: Mofenson reports no relevant financial disclosures.