Editor's Note: On the global journey to eliminate HIV infections among children, different countries and regions face distinctly different challenges. Recently, at the AIDS2024 conference, Dr. Kira Elsbernd from the University of Munich in Germany delivered a special report on the risk factors involved in HIV vertical transmission and was interviewed by Infectious Diseases Frontier(IIDF). Dr. Elsbernd pointed out that there are significant differences in the rates of HIV vertical transmission between Mozambique and Tanzania. Key factors such as age, duration of antiretroviral therapy, number of antenatal care visits, and viral load at the time of delivery play crucial roles. To effectively reduce the mother-to-child transmission rate of HIV, she emphasized the need for a deep understanding of these risk factors and the design of targeted interventions. Additionally, Dr. Elsbernd expressed optimism about emerging fields and technologies, such as point-of-care diagnostics and broadly neutralizing antibodies, which she believes will play a significant role in the future prevention of pediatric HIV.01
IIDF: Dr. Elsbernd, what are the key differences in risk factors you observed between high and low vertical HIV transmission settings?
Dr Elsbernd: We studied two countries – Mozambique and Tanzania – and observed significantly higher vertical transmission rates in Mozambique compared to Tanzania. The key individual factors that were associated with higher transmission in Mozambique were: younger age; less time on antiretroviral treatment; less antenatal care attendance; and the main factor (which is the only significant factor after adjusting for the others) was high viral load at delivery
02
IIDF: What specific interventions or policy adjustments do you consider most effective in high-risk settings to significantly reduce mother-to-child HIV transmission rates?
Dr Elsbernd: We can say from our data that interventions designed to reduce maternal viral load at delivery and during the postpartum period are essential for eliminating pediatric HIV. We need to better understand these factors and the complexities of these factors in order to design effective interventions.
03
IIDF: With technological advancements and the emergence of new medical technologies, what emerging fields or technologies do you believe have the potential to significantly impact the further reduction of pediatric HIV infections in the future?
Dr. Elsbernd: Point-of-care diagnosis and point-of-care viral load monitoring in particular are really nice tools, because you can have the result immediately and intervene immediately before the mother and child pair leave the contact with the healthcare system. So these are really good real-time monitoring tools, but we do need more effective HIV postnatal prophylaxis interventions to prevent new transmissions. And here, broadly neutralizing antibodies and other options for prophylactic treatment of infants are still warranted.
