The Cochrane Library and mother-to-child transmission of HIV: an umbrella review

Background The majority of HIV-infected children acquire the infection from their mothers. Preventing mother-to-child transmission (MTCT) of HIV is a key step in reducing the number of paediatric HIV infections. Objective To summarize the Cochrane reviews which have assessed the efficacy of interventions to prevent MTCT of HIV. Methods The Cochrane Database of Systematic Reviews was searched for any intervention to prevent MTCT of HIV. Data were extracted in duplicate and the GRADE assessment tool used to analyze the quality of extracted data. Main Results Five reviews met our inclusion criteria, and were of medium to high quality. One review examined the efficacy of antiretroviral prophylaxis for preventing MTCT of HIV. Each regimen used, ranging from the two-dose nevirapine regimen to combination regimens, such as zidovudine and lamivudine, reduced the risk of MTCT of HIV. A meta-analysis was not conducted as different regimens were used in the different trials. Caesarean section before labour and before ruptured membranes reduces the risk of MTCT of HIV (risk ratio [RR] 0.34, 95% confidence interval [CI] 0.14 to 0.8) compared to vaginal delivery. There was no evidence that vaginal disinfection (RR 0.94; 95%CI: 0.71 to 1.25), vitamin A supplementation (RR 1.10; 95%CI: 0.95 to 1.26), or hyperimmune HIV immunoglobulin (RR 0.67; 95%CI: 0.29 to 1.55) are efficacious interventions for the prevention of MTCT of HIV. There was no review on alternatives to breastfeeding. Authors' Conclusions Antiretroviral prophylaxis and caesarean section before labour and before ruptured membranes are efficacious in reducing the risk of MTCT of HIV. However, there is a need for research directed at (1) simplifying antiretroviral regimens to facilitate adherence and to minimize toxicity for both mothers and infants, (2) assessing the long-term impact of drug resistance on future treatment of HIV-infected mothers and infants, and identifying regimens that are less likely to induce resistance, and (3) assessing the efficacy of caesarean section among HIV-infected women with undetectable viral loads or who are receiving combination antiretroviral regimens. Copyright © 2007 John Wiley & Sons, Ltd.