Purpose of review: At a time when highly effective drugs to prevent peripartum transmission of HIV are readily available and affordable, HIV remains the single most important cause of the death of infants and young children in southern and east Africa.
Recent findings: Evidence from the past 5 years highlights four main points. The survival of children born to HIV-infected mothers relies on the mothers remaining well and alive. Suboptimal feeding practices of HIV-exposed infants can significantly increase infant mortality aside of any impact on postnatal transmission of HIV. Antiretroviral drugs are now available that can reduce morbidity and mortality in infected women as well as the transmission of HIV to their infants. Finally, the inability of health systems to deliver prevention of mother-to-child transmission services is the greatest obstacle to reducing HIV infection among infants and improving maternal and child survival.
Summary: The goal of improved maternal and child survival and not just the avoidance of HIV infection in infants must be the goal of prevention of mother-to-child transmission programmes. Research is needed to identify interventions that will improve the ability of health systems to deliver prevention of mother-to-child transmission services in addition to new and more effective therapeutic interventions.