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Advances and controversies in the prevention of HIV-1 mother-to-child transmission

Sri Lanka College of Venereologists
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  • Communicable Diseases
  • Hiv-1
  • Medicine


HIV-1 infection can be transmitted from mother-tochild in utero and intra-partum. In the absence of antiret roviral therapy, chorioamnionitis has been associated with transmission risk, as has duration of rupture of membranes. Chlorhexidine vaginal lavage reduced transmissiononce membraneswere ruptured more than 4 hours however antibiotics given in the 2nd trimester did not reduce transmission. Mode of delivery significantly impacts on transmission in the absenceof antiretroviral therapyand whenzidovudine is given as a monotherapy. Most risk factors are eliminated by highly active antiretroviral therapy (HAART)and transmission rates well below 1% are achievable. The role of pre-labour caesarean section (PLCS) in women with undetectable HIV viral load on HAART is now uncertain.The current major controversy is whether HAART, and especially protease-inhibitorcontainingregimens, are associated with a significant increase risk of severe pre-term delivery. Although some argue the case for full suppression of viral load in all pregnant women, most guidelines maintain an option for zidovudine monotherapy if baseline viral load is low and PLCS is the preferred mode of delivery. DOI: Sri Lanka Journal of Venereology Vol.2(1) 2009 pp.5-10

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