Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is a devastating consequence of HIV infection during pregnancy and is largely preventable. Evidence-based interventions such as universal antenatal screening, provision of antiretroviral therapy, delivery by elective caesarean section and avoidance of breastfeeding have ensured that the rates of MTCT remain low in Malaysia. This review discusses the most recent advances in the management of HIV infection in pregnancy with emphasis on antiretroviral treatment strategies and obstetric care in a middle income country
Pregnancy, whether actual or anticipated, has been a critical driver for the diagnosis, treatment and care of women with human immunodeficiency virus (HIV). Unlike other viral infections during pregnancy, maternal HIV infection is not associated with congenital abnormalities, adverse effects on the miscarriage rate or pregnancy outcome. Transmission of HIV from mother to child is the main concern. This can occur in utero, during delivery, or postpartum through breastfeeding. Most mother-to-child transmissions (MTCT) occur during delivery or through breastfeeding. The risk of transmission to the infant is directly proportional to the maternal plasma HIV viral load, the risk being greatest with higher viral loads. Without any intervention, up to 45% of children born to HIV positive mothers in lower income countries will become infected. This can be reduced to less than 2% with strategies to reduce MTCT.
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