Universal children’s day : let’s improve current interventions to reduce vertical transmission of HIV now
CITATION: Cotton, M. F. & Rabie, H. 2014. Universal children’s day : let’s improve current interventions to reduce vertical transmission of HIV now. Journal of the International AIDS Society, 17:19875, doi:10.7448/IAS.17.1.19875.
The original publication is available at http://www.jiasociety.org
By 2013, there was a 40% decline in new paediatric infections compared to 2009. Prevention of mother to child transmission (PMTCT) of HIV continues to reduce the frequency of HIV in infants through wider and earlier implementation of antenatal combination antiretroviral therapy (ART). Post-natally, breastfed infants are now protected from HIV infection through maternal ART and/or infant nevirapine (NVP). The ultimate aim is the elimination of vertical transmission of HIV. Should HIV infection occur in infants, the focus is on early detection and treatment. The children with HIV early antiretroviral (CHER) trial established the benefit of initiating ART at a median of seven weeks of age. The narrative of the Mississippi child focussed attention on very early diagnosis and therapy. This infant, whose mother was diagnosed as HIV-positive in labour, initiated ART 31 hours after delivery. After ART discontinuation from 15 to 21 months of age due to poor adherence, plasma HIV RNA remained undetectable on standard assays until almost four years of age, with only traces of HIV DNA being found using sophisticated assays.