Prevention of perinatal transmission of human immunodeficiency virus: a progress report 2 years after completion of AIDS Clinical Trials Group trial 076.

In this AIDS commentary, Dr. Wilfert has reviewed the American experience with vertical transmission of human immunodeficiency virus type 1 (HIV-1) since the closing of the 076 trial performed by the AIDS Clinical Trials Group in February 1994. The news generally is good; the rate of transmission from mother to child in nonstudy situations has been reduced when counseling and therapy are offered to pregnant women. As Dr. Wilfert emphasizes, the mechanism of the beneficial effect remains to be elucidated. More important, the resources required to insure that women have access to counseling and care need to be secured. In addition to these issues discussed by Dr. Wilfert, questions that need to be addressed include the efficacy and safety of more-potent antiretroviral agents or combinations in further reducing the risk of transmission, the optimal intervention for women who become pregnant while receiving antiretroviral therapy, the optimal postpartum management for women, and the most-effective treatment strategy for children born to infected women. The newborn child who is infected in spite of treatment of the mother potentially could receive great benefit from aggressive therapy designed to reduce the rate of viral replication and the selection of drug-resistant HIV-1. Finally, inexpensive and user-friendly methods of reducing the rate of vertical transmission in developing countries are urgently needed. Progress in reducing the prevalence of pediatric HIV-1 infection transmitted by mothers, the most common source of this infection in children, has been made, but further research and effort to insure access to care and answers to unsolved problems are necessary.