REPORT OF A CONSENSUS WORKSHOP, SIENA, ITALY, JUNE 3-6, 1993 - STRATEGIES FOR PREVENTION OF PERINATAL TRANSMISSION OF HIV-INFECTION

Worldwide clinical trials are in progress or are being planned to eval uate different interventions aimed at reducing transmission of human i mmunodeficiency virus (HIV) from mother to infant. Several new therape utic agents will soon be the focus of clinical trials to evaluate thei r safety for pregnant women and their infants and to test their effica cy in preventing perinatal transmission. Identification of the factors that influence the timing and mechanism of perinatal HIV transmission is essential to the assessment of interventions to reduce transmissio n. An international workshop was held on June 3-6, 1993, in Siena, Ita ly, to review what is known about the risk factors, timing, and mechan isms of HIV type 1 (HIV-1) transmission from mother to infant during g estation, birth, and lactation. Several possible interventions were co mpared with respect to their mechanism of action, their dependence upo n the mode and timing of perinatal HIV transmission, and their suitabi lity for incorporation into trials, alone or in combination, in variou s parts of the world. Obstetrical interventions such as caesarian sect ion or use of a virucidal vaginal lavage during labor, administration of antiretroviral drugs to mother and/or infant, as well as active and /or passive immunization were discussed. The role of breast-feeding in perinatal HIV infection and in the trials was also evaluated. Because the ability to enroll pregnant, HIV-infected women in trials is limit ed, it is essential that proposed trials be carefully evaluated for ad equacy of the sample size, appropriateness of the type of intervention to the particular population of women to be enrolled, and feasibility of the intervention. Worldwide coordination of perinatal intervention trials is essential to prevent duplication, allow the optimal use of human and financial resources, and ensure the most rapid possible eval uation and implementation of means to prevent pediatric HIV infection.