The ongoing HIV and AIDS pandemic is the deadliest pandemic since the Spanish flu 100 years ago, causing 32 million deaths so far and, despite enormous progress in treatments allowing people to live long, healthy lives, we still do not have a cure. There are still many challenges that need to overcome and one of them is mother-to-child transmission.
This occurs everywhere in the world but there have been particular difficulties in tackling it in middle- and low-income countries. In its efforts to eliminate mother-to-child transmissions, over the last decade, the World Health Organization (WHO) has recommended a regimen called Option B+ where expectant mothers and pregnant people living with HIV are offered antiretroviral treatments (ART) as early as possible in the pregnancy and then for life.
A new study published in The Lancet HIV has demonstrated that this approach should make it possible to eliminate mother-to-child transmission of the virus for good. Researchers from the Karolinska Institutet, Sweden, and the Muhimbili University of Health and Allied Sciences and Management and Development for Health looked at the effectiveness of Option B+ intervention in Tanzania.
Focusing on a population of pregnant women in Dar es Salaam (Tanzania's largest city), the data reported that 10,161 pregnant women with HIV were enlisted in the Option B+ care, and up to four years after starting the program, 90 percent of these women had suppressed viral levels. According to these findings, the researchers sa the WHO's goal of eliminating mother-to-child transmission is possible, and this is a way to do it.
"Our study confirms the lasting health benefits of life-long ART for women who go on Option B+ during pregnancy and therefore for their babies, too," lead author Dr Goodluck Lyatuu of the Department of Global Public Health at the Karolinska Institutet said in a statement.
While the findings are extremely positive, the study also documents some known and unexpected challenges. There are 1.7 million people between the age of 15 and 49 in Tanzania living with HIV. For the program to be truly successful, these extra barriers to care have to be addressed.
"The results also point to some other important challenges when it comes to deriving the full long-term benefits of Option B+. To focus, for example, on some subgroups of women, such as young mothers, mothers who start ante-natal care late during pregnancy and mothers with advanced HIV," Dr Lyatuu said.
In 2019, there were an estimated 150,000 new HIV infections among children under five. This is still an incredibly high number but is a great improvement from 2010 when the number was twice that. Since the start of prevention programs such as Option B+, UNICEF estimates that 1 million deaths and 2.2 million HIV infections have been averted among children.
Education and access to preventative drugs like Pre-Exposure Prophylaxis (PrEP) and antiretroviral treatments are key to successfully ending new HIV transmissions. People living with the virus on effective treatments can live a healthy and long life, and those whose viral load becomes undetectable can’t pass the virus on.
While science has made huge progress in tackling and treating this global pandemic, societal stigmatization – one of the reasons infections were not prevented from spreading in the early 1980s when it first emerged – is still a major hurdle that has the power to interfere with this success, and needs to be addressed.