aAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa bINSERM, Unité 593, Bordeaux, France cInstitut de Santé Publique Epidémiologie Développement, Université Victor Segalen Bordeaux 2, Bordeaux, France dCentre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, UK.
Curr Opin HIV AIDS. 2007 Sep;2(5):361-6. doi: 10.1097/COH.0b013e3282cecef4.
Mother-to-child transmission of HIV causes most paediatric HIV infections. Short-course peripartum antiretroviral therapy, available in resource-constrained settings, can reduce risk for transmission around the time of delivery. Acceptable, efficient and safe interventions aimed at reducing risk for postnatal HIV transmission through breast milk remain elusive, however.
This review summarizes current knowledge on interventions to reduce risk for postnatal transmission of HIV. New information from studies conducted in Africa, where breastfeeding is the norm, suggests that modified infant feeding practices are associated with reduced transmission risk, but women need support as well as appropriate care and nutritional counselling if they are to practise these feeding modes safely. In addition, antiretroviral therapy for HIV-infected breastfeeding mothers is a promising strategy to prevent HIV transmission through breast milk in Africa. The safety and efficacy of this strategy must be assessed within large African longitudinal studies using a variety of antiretroviral regimens.
Promising interventions to reduce risk for HIV transmission through breast milk do exist, but their implementation at a population level remains insufficient. Development of a safe, effective paediatric preventive HIV vaccine would be an important advance, with a major effect on control of the HIV/AIDS pandemic.
母婴传播是导致儿童感染 HIV 的主要途径。在资源有限的环境下，采用短疗程围产期抗逆转录病毒疗法，可降低分娩期间的母婴传播风险。然而，目前仍缺乏可接受、有效且安全的干预措施来降低通过母乳传播 HIV 的风险。
本综述总结了目前减少 HIV 产后传播风险的干预措施。在以母乳喂养为常态的非洲进行的研究提供了新信息，提示改良婴儿喂养方式与降低传播风险相关，但如果要安全实施这些喂养方式，妇女需要得到支持以及适当的护理和营养咨询。此外，针对 HIV 感染的母乳喂养母亲使用抗逆转录病毒治疗，是在非洲预防通过母乳传播 HIV 的一种有前景的策略。该策略的安全性和有效性需要在使用各种抗逆转录病毒方案的大型非洲纵向研究中进行评估。
确实存在降低通过母乳传播 HIV 风险的有前景的干预措施，但在人群层面的实施仍不足。开发一种安全、有效的针对儿童的预防性 HIV 疫苗将是一项重要进展，对控制 HIV/AIDS 大流行将产生重大影响。
