Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants

Recommendations for a public health approach (2010 version)

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Significant progress is being made in the global scale-up of prevention of mother-to-child transmission of HIV (PMTCT), including in high burden and resource-limited settings. For the first time, the elimination of mother-to-child transmission of HIV (MTCT) is now considered a realistic public health goal and an important part of the campaign to achieve the millennium development goals.

In the light of the global effort, it is critically important to provide the best evidence-based interventions to reduce the risk of transmission from an HIV-infected mother to her newborn child, while at the same time promoting the health of both the mother and the child.

Since WHO issued revised guidelines in 2006, important new evidence has emerged on the use of antiretroviral (ARV) prophylaxis to prevent MTCT, including during breastfeeding, on the optimal time to initiate antiretroviral therapy (ART) in individuals who need treatment, and on safe feeding practices for HIV-exposed infants.

This evidence forms the basis for the new recommendations contained in these 2010 revised guidelines and summarized in preliminary form in the 2009 Rapid Advice: Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. The Rapid Advice gives a list of the key recommendations whereas the full guidelines document presents in detail the scientific evidence and rationale supporting these recommendations. The detailed guidelines document provides the necessary information for countries to adapt the WHO recommendations to their local settings.

The 2010 guidelines are developed to provide international standards, primarily for low- and middle-income settings, in support of the global scale-up of more effective interventions aimed at preventing MTCT in resource-limited settings. Once implemented, these recommendations could reduce the risk of MTCT to less than 5% (or even lower) in breastfeeding populations from a background risk of 35%, and to less than 2% in non-breastfeeding populations from a background risk of 25%, and will ensure increased maternal and child survival.

The 2010 revision of the WHO guidelines on PMTCT complies with the recently updated WHO guidelines development process, which requires systematic review of new evidence for key questions and recommendations, as well as a consideration of programme feasibility and the cost implications of potential new recommendations. WHO has simultaneously revised guidelines for adult ART as well as HIV and infant feeding. All three sets of guidelines were updated in a harmonized fashion.

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