ICAP, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
J Acquir Immune Defic Syndr. 2013 Jul;63 Suppl 2:S208-12. doi: 10.1097/QAI.0b013e3182986f55.
Efforts to prevent the mother-to-child transmission (PMTCT) of HIV infection have encountered remarkable successes and considerable challenges around the globe. The reductions in vertical HIV transmission observed in Europe and North America have helped raise the possibility of the virtual elimination of new pediatric HIV infections and in turn an "AIDS-free generation". Yet in many resource-limited settings, preventable new pediatric infections continue to occur daily. Here, we consider what will be required to reach an end to the global pediatric HIV epidemic, and what we can hope for in the context of resurgent international interest. The science of PMTCT has advanced dramatically since the first evidence for the use of antiretroviral (ARV) drugs for PMTCT in 1994. The timing and causes of vertical transmission are now well understood, and this knowledge has led directly to highly efficacious PMTCT interventions based on the use of combination ARV regimens. The application of these interventions around the world has been uneven, however. Several African countries report good access to and uptake of PMTCT services and corresponding low rates of early mother-to-child transmission. However, limited population coverage of PMTCT programs with continued use of suboptimal ARV regimens still hamper prevention efforts in many other countries. Looking forward, reaching ambitious international targets to reduce pediatric HIV infections will require a combination of increased access to efficacious ARV regimens and strengthened health systems for maternal and child health, supported by continued strong political will and international attention.
全球范围内，预防母婴传播（PMTCT）艾滋病毒感染的努力取得了显著成功和重大挑战。欧洲和北美的垂直 HIV 传播减少，这使得新的儿科 HIV 感染几乎可以消除，从而实现“无艾滋病一代”。然而，在许多资源有限的环境中，每天仍有可预防的新儿科感染发生。在这里，我们将考虑实现全球儿科 HIV 流行终结所需的条件，以及在国际关注度再次上升的背景下我们可以抱有何种期望。自 1994 年首次提出使用抗逆转录病毒（ARV）药物预防母婴传播以来，PMTCT 的科学已经取得了巨大进展。垂直传播的时间和原因现在已经得到很好的理解，这一知识直接导致了基于联合 ARV 方案的高效 PMTCT 干预措施。然而，这些干预措施在全球的应用并不均衡。一些非洲国家报告称，PMTCT 服务的可及性和接受度良好，母婴传播的早期比率也相应较低。然而，在许多其他国家，PMTCT 方案的人口覆盖率有限，继续使用不太理想的 ARV 方案，这仍然阻碍了预防工作的开展。展望未来，要实现减少儿科 HIV 感染的国际宏伟目标，需要增加获得高效 ARV 方案的机会，并加强妇幼保健的卫生系统，同时需要持续的强烈政治意愿和国际关注提供支持。
