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  • Title: Preventing mother-to-child transmission: the options.
    Author: Saba J.
    Journal: Glob AIDSnews; 1995; (3-4):16-7. PubMed ID: 12346895.
    Abstract:
    Since millions of children have been and will be infected with HIV through mother-to-child transmission, the discovery that treatment of the mother with the antiretroviral drug zidovudine (AZT) can greatly reduce such transmission represents a major breakthrough. Unfortunately, most mother-to-child transmission occurs in developing countries where it would be impossible to support a 2-3 month course of AZT treatment in infected pregnant women. Also, the AZT studies performed in France and the US failed to address the issue of transmission during breast feeding. Research is needed to determine whether regimens of 2-4 weeks duration would be as effective in reducing transmission. Also, shorter courses of treatment may be possible using the viral load-reducing combination of AZT and the nucleoside analogue reverse transcriptase inhibitor lamivudine (which works faster and further than any other combination or than AZT alone). Other options for reducing maternal-child transmission include performing cesarean sections before the onset of labor, vaginal washing during labor, and the future option of vaccines to prevent transmission. Any new treatment should be submitted to a double-blind randomized controlled clinical trial in a setting similar to that in which it will be applied. Studies of HIV transmission during breast feeding have indicated that most transmission occurs in the first week postpartum and may be linked to colostrum. Other research has reported HIV transmission after 9-12 months of breast feeding. Studies on the risk of breast milk transmission should pay careful attention to issues of timing. In developing countries, the risk of HIV transmission with breast feeding is preferable to the risk of other infections and diarrheal diseases if breast feeding is avoided. Researchers should determine whether the interventions they plan to assess are applicable, especially in developing countries where large economic and social costs are associated with HIV testing of pregnant women.
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