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Review
. 2023 Mar 26;15(4):849.
doi: 10.3390/v15040849.

Prevention of the Vertical Transmission of HIV; A Recap of the Journey so Far

Maria Camila Cardenas  1 , Sheila Farnan  2 , Benjamin L Hamel  1 , Maria Camila Mejia Plazas  2   3 , Elise Sintim-Aboagye  2 , Dawn R Littlefield  2 , Supriya Behl  2 , Sohan Punia  2 , Elizabeth Ann L Enninga  4 , Erica Johnson  5 , Zelalem Temesgen  6 , Regan Theiler  4 , Clive M Gray  7 , Rana Chakraborty  2
Affiliations
Review

Prevention of the Vertical Transmission of HIV; A Recap of the Journey so Far

Maria Camila Cardenas et al. Viruses. .

Abstract

In 1989, one in four (25%) infants born to women living with HIV were infected; by the age of 2 years, there was 25% mortality among them due to HIV. These and other pieces of data prompted the development of interventions to offset vertical transmission, including the landmark Pediatric AIDS Clinical Trial Group Study (PACTG 076) in 1994. This study reported a 67.5% reduction in perinatal HIV transmission with prophylactic antenatal, intrapartum, and postnatal zidovudine. Numerous studies since then have provided compelling evidence to further optimize interventions, such that annual transmission rates of 0% are now reported by many health departments in the US and elimination has been validated in several countries around the world. Despite this success, the elimination of HIV's vertical transmission on the global scale remains a work in progress, limited by socioeconomic factors such as the prohibitive cost of antiretrovirals. Here, we review some of the key trials underpinning the development of guidelines in the US as well as globally, and discuss the evidence through a historic lens.

Keywords: HIV; antiretroviral therapy; breastfeeding; infants; prevention of vertical transmission; prophylaxis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Mechanisms of vertical transmission. Created in BioRender.
Figure 2
Figure 2
Line graphs illustrating the percentage of HIV-positive people on antiretroviral medication in terms of the prevention of VT from 2010 to 2021 (left) and the estimated vertical transmission rate globally from 2010–2021 (right).
Figure 3
Figure 3
“Neonatal HIV Categorization According to the Risk”. Adapted from Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce HIV Transmission in the United States. 30 December 2021. Created in BioRender.com.
Figure 4
Figure 4
Historical studies in the prevention of vertical transmission of HIV, 1989–1999. Created in BioRender.com.
Figure 5
Figure 5
Historical studies in the prevention of vertical transmission of HIV, 2000–2021. Created in BioRender.com.
See this image and copyright information in PMC

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