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Mother-to-child transmission of HIV-1 infection

2002; Elsevier BV; Volume: 360; Issue: 9333 Linguagem: Inglês

10.1016/s0140-6736(02)09794-5

1474-547X

Elizabeth Montgomery, Jennifer Wells, Linda Strani,

Poverty, Education, and Child Welfare

In her April 6 Commentary, Karen Beckerman1Beckerman KP Mothers, orphans, and prevention of paediatric AIDS.Lancet. 2002; 359: 1168-1169Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar calls for improved care of mothers in the battle to prevent mother-to-child transmission of HIV-1 infection, and notes the orphan crisis that is bound to emerge in the absence of antiretroviral treatment for the infected mothers. We believe the orphan burden may be much more serious than initially thought, which strengthens her argument.As members of a research collaborative between the University of Zimbabwe and Stanford University, we have, since July, 1999, been offering short course zidovudine and single-dose nevirapine (HIVNET 012 regimen) to HIV-1-positive pregnant women in Chitungwiza, Zimbabwe. Increasingly, women who receive antiretroviral prophylaxis are becoming pregnant again, despite the availability of free family planning. As antiretroviral prophylaxis for the prevention of mother-to-child transmission of infection becomes the standard of care in developing countries, more HIV-1-positive women will be able to have multiple healthy infants.If left untreated, these women will leave many orphans when they die and could be accelerating their own disease progression by having more children. Although results of some studies have shown that pregnancy itself does not affect CD4 and CD8 cell counts, the effect of breastfeeding on HIV-1 disease progression is still under debate. Personal interviews with these women have revealed many motivations for conceiving additional children, including: culture-based desire or pressure to have large families; non-disclosure of HIV status to husbands, which prevents negotiation of family planning; availability and efficacy of antiretroviral prophylaxis; and women's financial dependence on men some married women are threatened with divorce if they do not produce children, and some single women or AIDS widows are forced to marry and bear more children to support themselves and their existing children.We do not wish to imply that HIV-1-positive women should not conceive additional children, nor that these mothers should be treated solely for the purpose of preventing orphans. Rather, we wish to highlight the fact that multiple children will continue to be desired in many developing countries and that this phenomenon further supports the argument for antiretroviral treatment for HIV-1-infected mothers. The question remains, what to do in countries that are currently unable to treat mothers, because of cost, lack of infrastructure, or lack of will. We must ensure that HIV-1-positive mothers fully understand the potential consequences of having multiple children, and that our message respects human rights and the cultural and socioeconomic factors that affect reproductive decisions. In her April 6 Commentary, Karen Beckerman1Beckerman KP Mothers, orphans, and prevention of paediatric AIDS.Lancet. 2002; 359: 1168-1169Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar calls for improved care of mothers in the battle to prevent mother-to-child transmission of HIV-1 infection, and notes the orphan crisis that is bound to emerge in the absence of antiretroviral treatment for the infected mothers. We believe the orphan burden may be much more serious than initially thought, which strengthens her argument. As members of a research collaborative between the University of Zimbabwe and Stanford University, we have, since July, 1999, been offering short course zidovudine and single-dose nevirapine (HIVNET 012 regimen) to HIV-1-positive pregnant women in Chitungwiza, Zimbabwe. Increasingly, women who receive antiretroviral prophylaxis are becoming pregnant again, despite the availability of free family planning. As antiretroviral prophylaxis for the prevention of mother-to-child transmission of infection becomes the standard of care in developing countries, more HIV-1-positive women will be able to have multiple healthy infants. If left untreated, these women will leave many orphans when they die and could be accelerating their own disease progression by having more children. Although results of some studies have shown that pregnancy itself does not affect CD4 and CD8 cell counts, the effect of breastfeeding on HIV-1 disease progression is still under debate. Personal interviews with these women have revealed many motivations for conceiving additional children, including: culture-based desire or pressure to have large families; non-disclosure of HIV status to husbands, which prevents negotiation of family planning; availability and efficacy of antiretroviral prophylaxis; and women's financial dependence on men some married women are threatened with divorce if they do not produce children, and some single women or AIDS widows are forced to marry and bear more children to support themselves and their existing children. We do not wish to imply that HIV-1-positive women should not conceive additional children, nor that these mothers should be treated solely for the purpose of preventing orphans. Rather, we wish to highlight the fact that multiple children will continue to be desired in many developing countries and that this phenomenon further supports the argument for antiretroviral treatment for HIV-1-infected mothers. The question remains, what to do in countries that are currently unable to treat mothers, because of cost, lack of infrastructure, or lack of will. We must ensure that HIV-1-positive mothers fully understand the potential consequences of having multiple children, and that our message respects human rights and the cultural and socioeconomic factors that affect reproductive decisions.