Background

PLEASE NOTE: This review should be considered obsolete and outdated. Instead of this review, please refer to the following Cochrane reviews:

Read JS, Newell ML. Efficacy and safety of cesarean delivery for prevention of mother‐to‐child transmission of HIV‐1. Cochrane Database Syst Rev. 2005 Oct 19, Issue 4.

Wiysonge CS, Shey MS, Sterne JA, Brocklehurst P. Vitamin A supplementation for reducing the risk of mother‐to‐child transmission of HIV infection. Cochrane Database Syst Rev. 2005 Oct 19, Issue 4.

Wiysonge CS, Shey MS, Shang JD, Sterne JA, Brocklehurst P. Vaginal disinfection for preventing mother‐to‐child transmission of HIV infection. Cochrane Database Syst Rev. 2005 Oct 19, Issue 4.

Volmink J, Siegfried NL, van der Merwe L, Brocklehurst P. Antiretrovirals for reducing the risk of mother‐to‐child transmission of HIV infection. Cochrane Database Syst Rev. 2007 Jan 24, Issue 1.

Horvath T, Madi BC, Iuppa IM, Kennedy GE, Rutherford G, Read JS.. Interventions for preventing late postnatal mother‐to‐child transmission of HIV. Cochrane Database of Systematic Reviews 2009, Issue 1.

Sturt AS, Dokubo EK, Sint TT. Antiretroviral therapy (ART) for treating HIV infection in ART‐eligible pregnant women. Cochrane Database of Systematic Reviews 2010 , Issue 3 .

You may also wish to consult an "umbrella" review that covers some of the above (through 2007 publicaton):

Bond K, Horváth T, Harvey K, Wiysonge CS, Read JS. The Cochrane Library and mother‐to‐child transmission of HIV: an umbrella review. Evidence‐based Child Health: A Cochrane Review Journal 2007;2:4‐24.

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At the end of 1998 over 33 million people were infected with the human immunodeficiency virus (HIV) and over one million children had been infected from their mothers.

Objectives

The objective of this review was to assess what interventions may be effective in decreasing the risk of mother‐to‐child transmission of HIV infection as well as their effect on neonatal and maternal mortality and morbidity.

Search methods

The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched.

Selection criteria

Randomised trials comparing any intervention aimed at decreasing the risk of mother‐to‐child transmission of HIV infection compared with placebo or no treatment, or any two or more interventions aimed at decreasing the risk of mother‐to‐child transmission of HIV infection.

Data collection and analysis

Trial quality assessments and data extraction were undertaken by the reviewer.

Main results

Zidovudine
Four trials comparing zidovudine with placebo involving 1585 participants were included. Compared with placebo, there was a significant reduction in the risk of mother‐to‐child transmission with any zidovudine (relative risk (RR) 0.54, 95% confidence interval (CI) 0.42‐0.69). There is no evidence that 'long course therapy' is superior to 'short course therapy'.

Nevirapine
One trial compared intrapartum and postnatal nevirapine with intrapartum and postnatal zidovudine in 626 women, the majority of whom breast fed their infants. Compared with zidovudine, there was a significant reduction in the risk of mother‐to‐child transmission of HIV with nevirapine (RR 0.58, 95% CI 0.40‐0.83). No trials are available comparing nevirapine with placebo.

Caesarean section
One trial comparing elective caesarean section with anticipation of vaginal delivery involving 436 participants was included. Compared with vaginal delivery, there was a significant reduction in the risk of mother‐to‐child transmission of HIV infection with caesarean section (RR 0.17, 95% CI 0.05‐0.55).

Immunoglobulin
One trial comparing hyperimmune immunoglobulin plus zidovudine with non‐specific immunoglobulin plus zidovudine involving 501 participants was included. The addition of hyperimmune immunoglobulin to zidovudine does not appear to have any additional effect on the risk of mother‐to‐child transmission (RR 0.67, 95% CI 0.29‐1.55).

Authors' conclusions

Zidovudine, nevirapine and delivery by elective caesarean section appear to be very effective in decreasing the risk of mother‐to‐child transmission of HIV infection.