L3　特別講演: The progress in the prevention of mother to child transmission (MTCT) of HIV and its research in Africa

Preventing the new pediatric HIV infections is an utmost public health priority in low-resource settings, particularly in sub-Saharan Africa, with 2200 children newly infected daily in 2006, 90% of them resulting from the transmission of the virus from pregnant, delivering or lactating women. Clinical research has led to unprecedented progress in the field of MTCT and its prevention. Simple antiretroviral (ARV) prophylactic approaches have been proven to be safe, efficacious and feasible. Thus, MTCT in the peri-partum phase can be reduced by 30 to 75% compared to the spontaneous rate of transmission. Single-dose NVP was viewed as the «magic bullet» solution for PMTCT at the time of its discovery. The subsequent identification of the emergence of frequent viral resistance mutations has been a serious concern since then. Recent experiences in pregnant women of the use of highly potent combinations of ARVs have yielded MTCT rates as low as 2% in Africa, an achievement close to those in industrialized countries. Looking for new ARV strategies, including an alternative to single-dose NVP, and neonatal immunoprophylaxis for the prevention of breastfeeding transmission should be priority research areas. The other challenge is to make now the best possible use of currently available interventions to prevent pediatric HIV infection. It is documented that only 20% at best of targeted HIV-infected pregnant women benefit from the full package of interventions. Reasons are complex and multiple, and include lack of human and financial resources as well as the continuing fear and stigma around HIV infection by health care personnel and populations. Considering the current level of scientific progress, their translation into international and national guidelines and the rapidly progressing field use of ARVs, preventing pediatric HIV infection has the potential to greatly enhance child survival in low-resource settings.