Antiretroviral treatment for pregnant and breastfeeding women – the shifting paradigm
Commentary from AIDS supplement: 2013 WHO Consolidated Guidelines on the use of Antiretroviral drugs: Evidence and Implementation
The global community has called for the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Though viewed by some as overly optimistic and aspirational, this call to action has generated unprecedented momentum and transformed the global dialogue around prevention of mother-to-child HIV transmission (PMTCT) to emphasize efficiency, effectiveness and measurable impact of efforts to prevent new pediatric HIV infections. [...]
For the first time, the ART strategy for pregnant women is fully harmonized with the recommended first-line regimen for nonpregnant adults (once-daily tenofovir þ lamivudine/efavirenz þ emtracitabine). And, perhaps, more dramatically, the PMTCT regimen will no longer be determined by the woman’s health status. Rather, all women, irrespective of CD4þ T-cell count or clinical stage, will initiate standard first-line ART to reduce the risk of HIV transmission to the child and to her uninfected partners. For programmatic and operational reasons, particularly in generalized HIV epidemics, all pregnant and breastfeeding women with HIV should initiate ART as lifelong treatment (the ‘option Bþ’ approach), whereas in some countries, for women not eligible for ART for their own health, consideration can be given to stopping the antiretroviral drug regimen after the period of MTCTrisk has ceased (‘option B’).