Strategies for preventing late-term vertical HIV transmission

The significant decrease in HIV transmission rates from mother to child (vertical transmission) in developed countries is due largely to the implementation of the three-part AZT protocol. An abbreviated, two-part course of AZT preventive therapy has reduced vertical transmission in developing countries. Cesarean sections (C-sections) performed before the rupture of uterine membranes has also reduced vertical transmission. When elective C-sections are combined with AZT treatment, the rate of transmission drops from 7.3 percent to 2 percent. The mode of infant feeding has played a significant role in vertical transmission in developing countries. Studies suggest breast feeding accounts for more than one-third of all HIV infections in infants. Alternatives to breast feeding may reduce these rates, but issues such as cultural acceptance, formula misuse, and replacement-feeding availability must be addressed.