Antiretroviral Strategies for Preventing Mother-to-Child HIV Transmission

Mother-to-child HIV transmission remains a global priority, with elimination targets relying on comprehensive antiretroviral interventions. Transmission can occur in utero, intrapartum and during breastfeeding, with half of residual infections arising postnatally. Universal maternal antiretroviral therapy (ART) initiated before or during pregnancy and sustained through lactation reduces transmission risk to below 1%, while infant postnatal prophylaxis (PNP) offers an additional safety net. Programmes balance risk-stratified and non-stratified models to align with healthcare capacity, addressing challenges such as drug stockouts, formulation accessibility and retention across antenatal and postnatal care. Integration of point-of-care diagnostics, mobile health technologies and community-based delivery has enhanced adherence and monitoring. Emerging long-acting antiretrovirals and broadly neutralising antibodies hold promise to simplify regimens and overcome adherence barriers. These strategies, coupled with context-driven implementation, are pivotal to achieving the global goal of eliminating paediatric HIV by 2030.

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Antiretroviral Strategies for Preventing Mother-to-Child HIV Transmission publication trend

The graph below shows the total number of articles in antiretroviral strategies for preventing mother-to-child hiv transmission across all publications each year (not limited to Nature Index journals).

Technical terms

Antiretroviral therapy (ART): Combination drug regimens used to inhibit HIV replication and achieve viral suppression.

Postnatal prophylaxis (PNP): Administration of antiretroviral agents to an infant after birth to prevent HIV acquisition.

Viral load: Quantitative measurement of HIV RNA in the blood, with undetectable levels indicating effective suppression.

Long-acting antiretrovirals: Formulations designed for sustained drug release, reducing dosing frequency and improving adherence.

Broadly neutralising antibodies (bNAbs): Monoclonal antibodies targeting conserved HIV envelope regions to neutralise diverse viral strains.

References

1. Antiretroviral postnatal prophylaxis to prevent HIV vertical transmission: present and future strategies. Journal of the International AIDS Society (2023).
2. Preventing perinatal HIV acquisition; current gaps and future perspectives. Current Opinion in HIV and AIDS (2024).
3. 72 weeks post-partum follow-up of dolutegravir versus efavirenz initiated in late pregnancy (DolPHIN-2): an open-label, randomised controlled study. The Lancet HIV (2022).