HIV in children is predominantly acquired as a vertically transmitted disease. Without intervention the transmission rate from mother to child has varied from 20%-40%. However, this risk can be reduced to less than 2% with effective PPTCT (Prevention of parent to child transmission of HIV
Vertical transmission of HIV can occur in-utero through placental transmission, intrapartum through contact with infected birth canal secretions or postpartum through breast feeding. It is estimated that of the 30% of babies who get infected vertically, 2% get infected in early gestation, 3% get infected in late gestation, 15% get infected intrapartum and 10% get infected via breast feeding.
- Primary HIV infection in the mother due to high viremia
- Advanced HIV disease in the mother with high maternal viral load
- Prolonged rupture of membranes
- Premature delivery
HIV transmission from infected mother to child is mainly prevented by antiretroviral drug (ARV) prophylaxis to mother and baby, replacement feeding and elective caesarean section (ECS)
. ARV prophylaxis acts by reducing viral load in the mother and as post-exposure prophylaxis to the fetus and baby.Caesarean section before onset of labor or rupture of membranes has been used as an intervention for PPTCT to decrease risk of intrapartum transmission of HIV.
The goal of effective PPTCT is to ensure minimum risk of transmission of HIV from mother to child and ensuring a healthy mother and child at the end of intervention. The year 2009 was the turning point for the prevention of postnatal transmission of HIV where 3 randomized controlled trials found that antiretroviral prophylaxis
in pregnant women and their infants coupled with breast feeding
could lead to a significant decrease in the vertical transmission of HIV.