Chersich Matthew F, Gray Glenda E
Perinatal HIV Research Unit, University of the Witwaterstrand, Chris Hani Baragwanath Hospital, Old Potch Road, PO Berstham, Soweto 2013, South Africa.
Curr Infect Dis Rep. 2005 Sep;7(5):393-400. doi: 10.1007/s11908-005-0014-0.
There is a widening gulf between the effectiveness of interventions for preventing mother-to-child transmission (PMTCT) of HIV in sub-Saharan Africa and other regions of the world. Compared with long-course, triple antiretroviral regimens used in Brazil, Europe, and the United States, most countries in sub-Saharan Africa use a less effective regimen consisting of single-dose nevirapine (NVP). Furthermore, the documentation of unacceptable levels of resistance following this regimen makes it prudent to review current PMTCT strategies. Not only is it necessary to review the use of single-dose NVP for PMTCT, but efforts to minimize breast milk transmission of HIV should be enhanced. This review summarizes the programmatic and evidence-based reasons for adopting a standardized approach to long-course, triple-drug MTCT prophylaxis in sub-Saharan Africa. Antiretroviral treatment programs in resource-constrained settings have achieved similar levels of effectiveness as high-income countries, despite adopting standardized approaches to antiretroviral treatment. Similarly, in resource-constrained settings with adequate infrastructure and programmatic capacity, use of standardized, long-course, triple-drug regimens for MTCT prevention are likely to achieve levels of effectiveness seen in Brazil, Europe, and the United States.
在撒哈拉以南非洲地区与世界其他地区，预防艾滋病毒母婴传播（PMTCT）干预措施的有效性差距正在扩大。与巴西、欧洲和美国使用的长疗程三联抗逆转录病毒疗法相比，撒哈拉以南非洲的大多数国家使用的是效果较差的单剂量奈韦拉平（NVP）疗法。此外，该疗法出现不可接受的耐药水平的记录表明，有必要对当前的PMTCT策略进行审查。不仅有必要审查单剂量NVP用于PMTCT的情况，还应加强努力以尽量减少艾滋病毒通过母乳传播。本综述总结了在撒哈拉以南非洲采用标准化长疗程三联药物预防母婴传播的方案和循证理由。尽管资源有限地区的抗逆转录病毒治疗方案采用了标准化的抗逆转录病毒治疗方法，但其有效性水平已与高收入国家相当。同样，在具备适当基础设施和方案能力的资源有限地区，使用标准化长疗程三联药物方案预防母婴传播可能会达到巴西、欧洲和美国的有效性水平。
