Antiviral medication almost completely reduces the risk of mothers passing on HIV infection to their children, even in low-income countries.
According to a new study in Lancet HIV by researchers from Karolinska Institutet, antiviral medication almost completely reduces the risk of mothers passing on HIV infection to their children. This discovery will hopefully support the World Health Organization’s (WHO) goal of eliminating the spread of infection between mother and child.
The UN organisation UNAIDS estimates 11% of children born to HIV-positive mothers in Tanzania are infected with HIV in the womb, during childbirth or via breast milk. However, this number is most likely significantly lower in reality, the new study found.
Examining over 13,000 HIV-positive pregnant women
The researchers examined over 13,000 HIV-positive pregnant women at several health centres in Tanzania. The women were offered antiviral medication through maternity care between 2015 and 2017.
The women were followed for 18 months after giving birth when most of them had stopped breastfeeding. When the researchers examined the mothers’ children and discovered that only 159 of the 13,000 infants had been infected with HIV by the age of 1.5 years.
Furthermore, the risk of infection was more than twice as high in women who received late care during pregnancy or had advanced HIV. Contrastingly, the risk of infection was only 0.9% in those who had already received HIV treatment when they became pregnant.
“HIV transmission from mother to child can in principle be stopped completely with modern antiviral drugs. But so far it has not been demonstrated in low-income countries in Africa with a high incidence of HIV infection,” said Goodluck Willey Lyatuu, physician and postdoctoral researcher at the Department of Global Public Health at Karolinska Institutet and first author of the study.
Diagnosing HIV early is vital
WHO are aiming to eliminate the transmission of HIV infection from mother to child, and since 2012, the organisation introduced advice that all pregnant women with HIV should begin lifelong antiviral medication. As a result, this has led to a sharp reduction in the risk of transmission of infection between mother and child in resource-poor countries.
“However, it is still important to improve early HIV diagnosis, optimise follow-up measures and offer specialist support to young mothers,” said Anna Mia Ekström, clinical professor of global infectious disease epidemiology with a focus on HIV at the Department of Global Public Health at Karolinska Institutet and corresponding author of the study.
The study is limited by challenges that may be typical in low-resource health systems, such as incomplete follow-up and missing data, and that risk factors such as stigma linked to HIV are rarely or never routinely investigated.
“But it is one of the largest cohort studies published from Africa on the risk of HIV transmission from mother to child where the baby is followed until the end of the breastfeeding period,” added Anna Mia Ekström.