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      Update on successes and challenges regarding mother-to-child transmission of HIV.

      Current Opinion in Pediatrics

      Adult, Anti-Retroviral Agents, therapeutic use, Child, Child, Preschool, Comorbidity, Developed Countries, Developing Countries, Drug Resistance, Viral, Female, Global Health, HIV Infections, epidemiology, prevention & control, transmission, Health Services Accessibility, organization & administration, Humans, Infant, Infant, Newborn, Infectious Disease Transmission, Vertical, Mother-Child Relations, Practice Guidelines as Topic, Pregnancy, Pregnancy Complications, Infectious, Preventive Health Services, methods, Risk Factors, Treatment Outcome

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          There is an unprecedented global commitment to reverse the pediatric HIV epidemic by making prevention of mother-to-child transmission (PMTCT) services accessible in all countries. This review outlines the successes made and the challenges that remain. In resource-rich countries, mother-to-child transmission rates of HIV as low as 1% have been achieved. The efficacy of short-course antiretrovirals for PMTCT in Africa is estimated at 50%. Coinfections with herpes simplex virus type 2, other sexually transmitted infections resulting in genital ulcers, and endemic infectious diseases (e.g., malaria) may increase the risk of mother-to-child transmission of HIV. Vertical transmission of drug-resistant viruses has been reported; the prevalence and effect of transmitted resistant virus on treatment outcomes are under investigation. Obstacles facing PMTCT in resource-limited countries include the lack of healthcare infrastructure, limited manpower, and competing public health priorities with the limited healthcare budget. Although the birth of an HIV-infected child in a resource-rich country is now a sentinel health event, in most resource-limited countries the birth of an HIV-infected child continues to be the status quo. Comprehensive PMTCT, including antiretroviral treatment for HIV-infected women and children, should be paramount in resource-limited countries.

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