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We know, in theory and increasingly in practice, how to dramatically reduce rates of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) type 1 (HIV-1). Specifically, perinatal transmission of HIV-1 can be lowered from 40% [1, 2] to <2% [3] with the use of a combination of antiretroviral drugs during pregnancy and labor (with or without cesarean section); brief infant prophylaxis with antiretroviral agents; and avoidance of breast-feeding. However, this reduction can be achieved only when we are aware of the presence of maternal HIV-1 infection and are able to intervene

The Joint United Nations Programme on HIV/AIDS estimated that, in 2007, only 1 in 3 HIV-infected pregnant women worldwide received any intervention to prevent MTCT [4]. Implementation of MTCT prevention interventions has been hindered by a multitude of factors globally, including limited or late access to antenatal care and to maternal HIV and CD4 testing; scarcity of trained health care workers to administer testing and treatment; cost of and adherence to antiretroviral drugs; and concerns regarding the safety, cost, and acceptability of replacement feeding. In this editorial commentary, we focus on one particularly formidable challenge to MTCT prevention efforts—one that has largely been overlooked: maternal HIV-1 acquisition during pregnancy or breast-feeding

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Editorial Commentary
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