On the road to eliminating HIV in babies

South Africa’s prevention of mother-to-child transmission programme has achieved remarkable successes. It has improved the health and life expectancy of pregnant women living with HIV, and reduced the risk of transmission of the virus to their offspring.

HIV can be transmitted during pregnancy, at delivery and through breastfeeding. The most critical intervention is to ensure the mother has undetectable HIV viral load levels in her blood by providing effective antiretroviral treatment (ART).

Access to ART for pregnant women was introduced in 2004 and has evolved. In 2015, antenatal services for pregnant women were further improved by providing access to lifelong ART. As a result, SA’s programme is a global leader, with more than 95% of women tested for HIV during antenatal care. More than 90% of HIV-positive women are now put on ART, up from 57% in 2007. Without any intervention, the HIV-infection rate was 40%. With these interventions the HIV-infection rate at birth is currently one percent.

The aim now is to eliminate mother-to-child transmission completely, but this requires innovative strategies. Maternal viral suppression rates must be improved, particularly after the birth, to achieve reduced HIV transmission during breastfeeding, viral suppression in future pregnancies and reduced HIV transmission to partners.

The department of health has thus revised the guidelines to include a strong focus on maternal viral suppression during antenatal care, at delivery and after birth. The new drug dolutegravir is a gamechanger. It rapidly suppresses viral load, has few side-effects and the virus doesn’t easily develop resistance to it. But data suggests there’s a risk of neural tube defects in the babies of women falling pregnant on the drug.

Also new is that all women have a viral load test at delivery to facilitate a response to ensure viral suppression during breastfeeding. A viral load test has also been introduced at six months after delivery for all women on ART, and an HIV test at six months for HIV-negative but exposed infants.

Finally, the breastfeeding period is now the “new frontier” for prevention as more than half of transmission occurs in the six months after delivery. To improve viral suppression, the new guidelines link mothers back into post-delivery care and ensure drug regimens are adhered to. To cut transmission through breast milk, efforts are being made to provide infant prophylaxis until maternal viral suppression is achieved.

Ute Feucht: Associate professor University of Pretoria; Jeannette Wessels: Researcher, UP

Republished from Theconversation.com