Pharmacological Prevention and Treatment of Maternal and Neonatal HIV Infection

[Speaker] Natella Rakhmanina:1,2
1:Pediatrics, Children's National Medical Center, The George Washington University, USA, 2:Elizabeth Glaser Pediatric AIDS Foundation, USA

The development of antiretroviral therapy formed the roadmap for the universal control and prevention of existing and new human immune deficiency virus (HIV) infections, respectively. Since the early 1990s administration of prophylactic antiretroviral therapy to pregnant women to assure prevention of the mother-to-child transmission has proven the most efficient and cost-effective way to achieve control of pediatric HIV infection. In the countries with consistent access to antiretroviral therapy and universal prevention of mother-to-child transmission the number of pediatric HIV infections has decreased to lees than 2%. In the last decade, specifically, much progress has been made in the universal antiretroviral treatment coverage of women during pregnancy and labor in resource-limited settings. Despite this progress, the rates of HIV infection among adolescent girls and young women in the areas most affected by HIV epidemic remain high, reflecting the continued mother-to-child transmission. With an estimated more than 2 million of children living with HIV infection, the delivery of effective well tolerated antiretroviral therapy to the world's pediatric population is of crucial importance. As with any other innovative therapeutic modality, however, the data guiding the dosing, efficacy and safety of antiretroviral drugs for pregnant and lactating women and children have lagged substantially behind as compared to the information available for adults. Given the high numbers of HIV-infected pregnant and lactating women and children with access to antiretroviral therapy globally, a better understanding of the therapeutic targets of antiretroviral drugs during pregnancy, lactation and for neonatal and pediatric HIV infection is needed. This lecture will provide an overview of the most recent approaches to using antiretroviral drugs to prevent mother-to-child transmission of HIV infection during pregnancy, delivery and throughout breastfeeding. The lecture will provide an update on the therapeutic management of HIV in newborns, infants, children and adolescents living with HIV. Special attention will be placed on the pharmacokinetics and pharmacodynamics of the antiretroviral drugs in pediatric populations with the focus on the role of therapeutic targets and therapeutic drug monitoring in improving the outcome of antiretroviral treatment in these vulnerable populations.
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