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

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.

Automated summary

In 1989, a quarter of infants born to HIV-infected women were also infected and had a 25% mortality rate by the age of 2. The development of interventions, including the PACTG 076 study in 1994, led to a 67.5% reduction in HIV transmission through the use of zidovudine. Many studies have since optimized interventions, leading to annual transmission rates of 0% in the US and elimination in other countries. However, global elimination is hindered by socioeconomic factors. We review key trials and discuss the evidence in a historical context.