INDICES> Prevention of mother to child transmission of HIV

[ichitsike <ichitsike@healthnet.zw>]

INDICES: Prevention of mother to child transmission of HIV
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Regarding the querry on the latest recommendations to prevent mother to child
transmission of HIV, it really depends on whether it is meant for developing
countries or rich developed countries.

In developing countries the latest recommendations for the majority is still
the Thai Short Course, which is Zidovudine
300 mg BD commencing 36 weeks gestation until labour. During labour the mother
gets 300 mg 3 hrly until delivery. The baby is not given any antiretroviral and
the baby is not breastfed if possible.  This reduces transmission by 51%.
However there are people who would still give the baby a week of Zidovudine at
2mg per kg every 6 hours.

The main problem is what to do about infant feeding. What we recommend to
mothers who receive Zidovudine but are unable for either economic or social
reasons to give formula, is to exclusively breast feed for at least 3 months.

Regarding Nevirapine the standard dose is 200 mg ( 1 tab) to the mum during
labour and one dose 2mg per kg to the baby within 72 hours of birth but not 
before 8 hours of birth. This reduces transmission by 47% and this effect is seen 
up to 3 months in a breast fed baby.  This is highly recommended
for mothers who present too late to receive Thai short course or women who
present in labour. As far as I know the Nevirapine is still not registered by
the manufactureres for use for prevention of mother to child transmission.

The main issue regarding use of NVP in high prevalance areas is whether it
should be given universally without testing. This is a very simple and cheap
intervention and one is tempted to give it to all pregnant women without testing
which requires counselling and is time consuming and expensive.  This approach
however is counter productive in the long term and would seriously undermine the
long lasting benefits of testing and knowing one's status.  As far as possible
universal NVP should be discouraged.

Recommendations for other richer countries or communities has been the 076
protocol ( long course AZT) plus elective
caesarian section and no breastfeeding. This reduces transmission by 98%. 
However more pregnant woemn are now receiving combination therapy and that is
maintained in pregnancy as long as Zidovudine is in the combination.

Dr ( Mrs)  Inam Chitsike
Paediatrician
Zimbabwe MTCT Project Officer
e-mail: ichitsike@healthnet.zw
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