Working to Advance Research on Preventing Mother-To-Child Transmission (MTCT) of HIV and Other Infections
For more than 30 years, a major goal of NICHD has been to reduce MTCT of HIV and other infections. Institute-supported research has identified practices and drug combinations that are very effective in preventing MTCT of HIV. As a result of this research, transmission rates in the United States have dropped to less than 1%.
In many resource-poor regions, similar efforts have not been as successful. Outside of the United States, about 330,000 infants are infected with HIV during pregnancy, birth, or breastfeeding each year, according to the Centers for Disease Control and Prevention (CDC). Most of these infections occur in sub-Saharan Africa.
In addition, those who are HIV positive are at higher risk for other infections that can also pass from mother to child during pregnancy, birth, or breastfeeding. These include hepatitis B virus (HBV) and tuberculosis (TB), among others. Among women who are HIV negative, other infections, such as cytomegalovirus (CMV), can pass from mother to child and can cause both short- and long-term health problems.
Several NICHD projects aim to understand the underlying biology of these infections as a way to prevent them from occurring and from being transmitted from mother to child. Select a link below to learn more about these efforts.
For decades, NICHD-supported research has made major advances in understanding and preventing MTCT of HIV. This important work continues, with multiple efforts in sub-Saharan Africa.
In November 2012, the NICHD joined the Department of State’s Office of the U.S. Global AIDS Coordinator to award $7.5 million to researchers in seven African countries to improve efforts to prevent MTCT of HIV. The research will focus on:
- Finding the best prevention methods
- Increasing women’s participation in prevention programs
- Increasing HIV testing and education in male partners
- Using “buddy systems” to help mothers practice safe feeding
- Comparing faith-based and clinic-based prevention programs
- Increasing the rates of early diagnosis of HIV in infants
- Looking at the effect of prevention programs on mother and infant health
The NICHD and the National Institute of Allergy and Infectious Diseases (NIAID) are also supporting a study called Promoting Maternal-Infant Survival Everywhere, or PROMISE. This study aims to find the best way to reduce the risk of HIV transmission from mothers to children during pregnancy, birth, and while breastfeeding. PROMISE researchers will give an HIV drug cocktail to infected mothers and study how well it prevents infection in infants and preserves mothers’ health. Read more at The “PROMISE” of Research.
The Institute’s research addresses other infections that are more common among women with HIV or that can be passed from mother to child during pregnancy, childbirth, or breastfeeding. Some of these efforts include:
- The NICHD’s Maternal and Pediatric Infectious Disease Branch (MPIDB) and the CDC are supporting a study on preventing MTCT of HBV in Thailand, where all infants receive standard HBV immune globulin (HBIG) injections and HBV vaccine series beginning right after birth. Despite these standard treatments, 10% to 12% of infants born to HBV-infected mothers with high levels of the virus become infected. The researchers will study how well an experimental treatment given to pregnant women with high levels of HBV (“e-Antigen positive”)—in addition to the standard infant HBIG injections and HBV vaccine series—prevents HBV infection in their infants. Read more about this grant at Antiviral Prophylaxis to Prevent Perinatal Transmission of HBV in Thailand.
- A large study in South Africa, also supported through the MPIDB, will evaluate the impact of TB treatment on outcomes in HIV-positive pregnant women and their infants. The study will determine if TB treatment reduces HIV transmission and progression and improves pregnancy outcomes. The research will also examine how TB treatment affects the levels of HIV drugs in HIV-positive pregnant women. Read more about this project at Impact of TB on Outcome of HIV in Pregnant Women.
- Two studies being conducted through the Maternal-Fetal Medicine Units (MFMU) Network, which is funded by the Pregnancy and Perinatology Branch (PPB), also aim to prevent and understand prenatal infections.
- CMV is a common infection. Although it is usually harmless in healthy children and adults, it can cause serious disease in babies who are infected with CMV before birth (often called congenital CMV). About 1 of every 5 children born with congenital CMV will develop permanent health problems, such as hearing loss and developmental disabilities, from the infection. The Randomized Trial to Prevent Congenital CMV Infection will examine whether giving CMV hyperimmune globulin to women diagnosed with primary CMV before they are 24 weeks pregnant reduces congenital CMV in their infants.
- MFMU Network researchers are also conducting a study to identify risk factors that are associated with MTCT of hepatitis C virus (HCV). HCV can cause liver problems, including chronic liver disease, cirrhosis of the liver (scarring) and increased risk of liver cancer. The Observational Study of Hepatitis C Virus in Pregnancy is currently enrolling participants.
Ongoing research supported by the NICHD aims to reduce new pediatric infections in the United States as well as globally. Through its many projects and scientific advances, the Institute’s goal is to enhance the health of children, adolescents, and women with infections such as HIV/AIDS, TB, CMV, HBV, and HCV so that they can lead healthier lives, free of many of the consequences of these infections.
For more information on this topic, select one of the following links:
- Research discussed in this spotlight
- Antiviral Prophylaxis to Prevent Perinatal Transmission of HBV in Thailand
- NICHD News Release: HPV vaccine may benefit HIV-infected women
- Impact of TB on Outcome of HIV in Pregnant Women
- NICHD-Supported Research Network: Maternal-Fetal Medicine Units (MFMU) Network
- NICHD Resources
- NICHD Related A to Z Topics:
- Maternal and Pediatric Infectious Disease Branch (MPIDB), formerly the Pediatric, Adolescent, and Maternal AIDS (PAMA) Branch
- PAMA Branch, Report to the NACHHD Council, June 2007 (This is a scientific document geared toward an audience of researchers and scientists. Note: As the result of a reorganization in 2012, the PAMA Branch is now the Maternal and Pediatric Infectious Disease Branch)
- Pregnancy and Perinatology Branch (PPB), formerly the Pediatric, Adolescent, and Maternal AIDS (PAMA) Branch
- PPB Report to the NACHHD Council, September 2008 (PDF - 1.17 MB) (This is a scientific document geared toward an audience of researchers and scientists.)
- Previous Related NICHD Spotlights:
- U.S. Department of State News Release: U.S. Government Announces Implementation Science Awards on Prevention of Mother-to-Child Transmission of HIV
Originally Posted: February 28, 2013