Landmark Developments in Pediatrics: 1995-2015
Russell W. Steele, MD
In 1994, a major advance in the prevention of HIV infection was achieved by treating infected mothers with zidovudine during their pregnancies, reducing vertical transmission by more than two thirds, from 27% to 7%. The addition of elective cesarean section further decreased transmission by more than one half. Subsequently, highly active antiretroviral therapy (HAART) in mothers reduced transmission to just 1% with vaginal deliveries. Not only is acquisition of disease in neonates now rare, but since 1995, mortality and morbidity for HIV-infected children have declined dramatically as a result of HAART. HIV-infected children can now expect to live healthy, productive lives.
Other major advances in HIV management are in the areas of diagnosis and detection of the virus. The newer, real-time PCR assays are capable of detecting as few as 40-50 virus copies/mL; this is significantly more sensitive than the earlier PCR assays, which required > 10,000 copies/mL. This allows much earlier diagnosis in patients who have been exposed to the virus, provides important information to prevent transmission, and is used to make decisions for method of delivery (vaginal vs cesarean section) for infected pregnant women.
Prevention and Treatment of HIV Infection
Russell W. Steele, MD
In 1994, a major advance in the prevention of HIV infection was achieved by treating infected mothers with zidovudine during their pregnancies, reducing vertical transmission by more than two thirds, from 27% to 7%. The addition of elective cesarean section further decreased transmission by more than one half. Subsequently, highly active antiretroviral therapy (HAART) in mothers reduced transmission to just 1% with vaginal deliveries. Not only is acquisition of disease in neonates now rare, but since 1995, mortality and morbidity for HIV-infected children have declined dramatically as a result of HAART. HIV-infected children can now expect to live healthy, productive lives.
Other major advances in HIV management are in the areas of diagnosis and detection of the virus. The newer, real-time PCR assays are capable of detecting as few as 40-50 virus copies/mL; this is significantly more sensitive than the earlier PCR assays, which required > 10,000 copies/mL. This allows much earlier diagnosis in patients who have been exposed to the virus, provides important information to prevent transmission, and is used to make decisions for method of delivery (vaginal vs cesarean section) for infected pregnant women.
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