Despite the progress made, prevention of perinatal transmission is predicated on identification of pregnant women with HIV and provision of prenatal care with institution of antiretroviral therapy and other preventive measures. More work is needed to identify barriers to prenatal care, effective strategies to combat drug use, and consideration of aggressive intrapartum treatment options.
Studies continue to define variables associated with perinatal transmission.
This suggests that different selective pressures may be involved in determining the pattern of viral strain transmission depending on timing of transmission. Breastfeeding The issue of breastfeeding and transmission is more important than ever, since breastmilk transmission of HIV may significantly attenuate the benefits of short-course antiretroviral regimens, such as nevirapine, that offer such hope to the developing world, where most perinatal transmission occurs. Replacement feeding carries a risk of infection because unsafe water supplies and lack of breast milk-acquired immunity may increase the likelihood of malnutrition. Interestingly, these detectable immune responses appeared to provide complete protection against subsequent HIV transmission at delivery and through breastfeeding. The use of antiretroviral agents remains the key intervention for reducing perinatal transmission in both the developed and developing world.