treatment for prevention of mother-to- child HIV transmission.

Prevention of mother-to-child transmission

Potential impact of new WHO criteria for antiretroviral treatment for prevention of mother-to- child HIV transmission.

The authors reviewed the potential impact of new WHO criteria for antiretroviral therapy using data from 1025 HIV-infected women and infants followed for 24 months in Lusaka, Zambia. The new criteria require initiating therapy among 68% of pregnant women and, if fully effective, would prevent 92% of maternal deaths and 88% of perinatal and postnatal infections. Using CD4 cell count below 350 cells/microlitres, irrespective of clinical stage, is more efficient and stricter CD4 cut-offs would be counter-productive.

This analysis of a Zambian cohort of pregnant women with HIV infection provides evidence-based support for the new WHO treatment guidelines which recommend antiretroviral treatment for adults with clinical stage III or IV, regardless of CD4 cell count, or with CD4 cell count below 350 cells/ul regardless of clinical stage. Not only would their immediate implementation reduce maternal mortality and HIV transmission to infants, it would protect the health of children who would otherwise become orphans. Furthermore, using either viral load or CD4 count as criteria for initiating theory lead to even better results while treating slightly fewer women – a cost-effectiveness argument for expanding access to viral load testing.