Antiretroviral regimens for preventing HIV infection in infants.

Several initiatives have been launched to reinforce countries’ efforts to scale up programmes for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) infection, though the shift from donor-funded projects and limited initiatives towards nationwide programmes is very slow. Coverage of PMTCT programmes and uptake of services provided through them are still very low worldwide (1). Provision of antiretroviral (ARV) drugs to mothers and infants is one of the key interventions for the prevention of HIV infection in infants. Various short-course ARV regimens have been shown to reduce significantly HIV peripartum transmission in both breastfeeding and non-breastfeeding populations in resource-constrained settings (2–5). Pilot programmes have been implemented to offer these interventions to a large number of women and infants, with varying degrees of success. Concerns have been raised, however, about their mid-term and long-term effectiveness at population level. In sub-Saharan Africa where breastfeeding is the norm, their overall efficacy is diminished, but not outweighed, over time by postnatal transmission through breastfeeding (6). So far, single-dose nevirapine (NVP) has been considered to be the most cost-effective regimen in settings where antenatal care coverage is low and where pregnant women do not present until late in pregnancy. Recent evidence strongly supports the use of combination regimens, especially shortcourse zidovudine (AZT) and singledose NVP, to achieve a more dramatic reduction in perinatal transmission of HIV (7, 8). That combination regimen is now recommended as one of the simplest, highly efficacious regimens, but its large-scale introduction has been problematic (9, 10). The article in this issue by David Coetzee et al. (pp. 489–494) focuses