PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV/AIDS

INTRODUCTION

Acquired Immune Deficiency Syndrome (AIDS) is an infectious disease, an epidemic affecting the entire world community, and a scourge, which has plagued humanity so severely though discovered only in the early 1980s. Virtually, everybody is capable of contracting the infection or developing full-blown disease. It is caused by a virus called the Human Immuno-deficiency Virus (HIV). At present, there has not been any solution to this disease and it carries 100% fatality. This implies that once infected, the disease has the capability of eventually killing the individual.

AIDS is no longer a disease of certain groups of people or sector of society, it thrives in people irrespective of age, sex, class; nor is it ethnical. The disease can be transferred to another by any condition that allows the exchange of body fluids, since the infective organism thrives in blood, semen, vaginal secretions, plasma, serum, breast milk etc.

About 80% of cases are transmitted through heterosexual relations, while the rest are gotten through the placenta to an unborn baby during pregnancy, through injection by use of unsterile needle, syringe, during blood transfusion, wound dressing, through other surgical interventions like ear piercing, circumcision, tissue transplant and other invasive procedures. One of the means of transmission in which we must make mention of is the “Mother-to-Child” transmission which becomes the basis of our discussion.

WHAT IS MOTHER-TO-CHILD TRANSMISSION?

Mother-to-child transmission (MTCT) is when an HIV positive woman passes the virus to her baby. This can occur during pregnancy, labour and delivery, or breastfeeding. Without treatment, about 15 – 30% of babies born to HIV positive women will become infected with HIV during pregnancy and delivery. A further 5- 20% will become infected through breast-feeding. Mother-to-child transmission (MTCT) has become a major problem as investigation in recent time precisely 2007 reveals that 370,000 children under 15 became infected with HIV, mainly through mother-to-child transmission. About 90% of these MTCT infections occurred in Africa where AIDS is beginning to reserve decades of steady progress in child survival which I suppose should be to lack of awareness about preventing mother-to-child transmission of HIV (PMTCT).

As a mean of orientation, effective mother-to-child transmission (PMTCT) requires a three-fold strategies which would be started below:

· Preventing HIV infection among prospective parents.

· Avoiding unwanted pregnancies among HIV positive women.

· Preventing the transmission of HIV from HIV positive mothers to their infants during pregnancy, labour delivery and breastfeeding. The last aspect is what we will major on as these can be achieved by the use of antiretroviral drugs, safer infant feeding practices and other interventions.

ANTIRETROVIRAL DRUGS

This drug is used for the treatment of women who have reached the advanced stages of HIV disease require a combination of antiretroviral drugs for their own health. This treatment, which must be taken every day for the rest of a woman’s life is also highly effective at preventing mother-to-child transmission (PMTCT). Women who require treatment will usually be advised to take it beginning either immediately or after the first trimester. Their new born babies will usually be given a course of treatment for the first few days or weeks of life, to lower the risk even further. Pregnant women who do not yet need treatment for their own HIV infection can take a short course of drugs to help protect their unborn babies. The main options are outlined below, in order of complexity and effectiveness.

SINGLE DOSE NEVIRAPINE

The simplest of all PMTCT drug regimens was tested in the HIVMET 012 trial, which took place in Uganda between 1997 and 1999. this study found that a single dose of nevirapine given to the mother at the onset of labour and to the baby after delivery roughly halved the rate of HIV transmission. Since 2000, many thousands of babies in resource-poor countries have benefited from the simple intervention since it is relatively cheap and easy to administer. A significant concern about the use of single dose nevirapine is drug resistance around one-third of women who take single dose nevirapine develop drug resistant HIV, which can make subsequent treatment involving nevirapine and etavirenz ( a related drug) less effective over time. Whenever possible, women should receive a combination of drugs to prevent HIV resistant problem and to decrease MTCT rates although these would be much more expensive.

COMBINING AZT WITH SINGLE DOSE NEVIRAPINE

According to World Health Organization (WHO) guidelines, the regimen currently recommended for preventing mother-to-child transmission (PMTCT) in resource-limited settings uses a combination of AZT and single dose nevirapine. This approach is much more difficult to administer than single dose nevirapine on its own, but it is also significantly more effective, and less likely to lead to drug resistance.

WHO guidelines for PMTCT drug regimens in resource-limited settings is as shown below:

	PREGNANCY	LABOUR	AFTER BIRTH (MOTHER)	AFTER BIRTH: (INFANT)
Recommended	AZT after 28 weeks	Single dose nevirapine: AZT + 3TC	AZT + 3TC	Single dose nevirapine AZT for 7 days
Alternative (higher risk of drug resistance)	AZT after 28 weeks	Single dose nevirapine	-	Single dose nevirapine; AZT for 7 days.
Minimum (less effective)	-	Single dose nevirapine AZT + 3TC	AZT + 3TC for 7 days	Single dose nevirapine
Minimum (less effective higher risk of drug resistance)	-	Single dose nevirapine	-	Single dose nevirapine.

NB: If the woman receives at least four weeks of AZT during pregnancy, doctor may choose to omit her dose of nevirapine from the recommended regimen.

HIV AND SAFER INFANT FEEDING

A number of studies have shown that the protective benefit of drugs is diminished when babies continue to be exposed to HIV through breastfeeding. Mothers with HIV are advised not to breastfeed whenever the use of breast milk substitutes (formula) is acceptable, feasible, affordable, sustainable and safe. However, if they live in a country where safe water is not available then the risk of life-threatening conditions from formula feeding may be higher than the risk from breastfeeding. A baby fed on infant formula does not receive the special vitamins and protective agents found in breast milk. And the cost of infant formula often puts it beyond the reach of poor families in resource poor countries. However, for HIV positive women who choose to breastfeed, exclusive breastfeeding is recommended for the first months of an infant’s life and should be discontinued once an alternative form of feeding becomes feasible.

CONCLUSION

It has been observed that though PMTCT services are available not all women receive the full benefit because of the following reasons:

Not being offered an HIV test, refusing to take an HIV test, not returning for follow up visits, not adhering to self-administered drugs. To achieve a high success rate, PMTCT programmes must have well-trained, supportive staff who take great care to ensure confidentiality. They must be backed up by effective HIV testing and counseling programmes and by good quality HIV/AIDS education, which is essential to eliminate myths and misunderstandings among pregnant women, and to counter stigma and discrimination in the wider community. Under these conditions, antiretroviral drugs have the potential to save many thousands of babies’ lives.