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The HIV NET 012 protocol for prevention of perinatal transmission of HIV, a single-dose of nevirapine given to the mother during labor and one given to the newborn, has been adopted by several developing countries. The implementation of this protocol may be difficult in African rural regions and must be evaluated. The study was carried out at the Oicha General Hospital, Democratic Republic of Congo. HIV-infected women with a gestational age > or =36 weeks were offered participation in the study during a prenatal visit. Among the 5,016 women tested during prenatal attendance from December 2002 to December 2004, 94 (1.9%, 95% confidence interval [CI]: 1.5-2.3%) were HIV-infected. Among these women, 59 (62.8%; 95% CI: 53.0-72.6%) received nevirapine and 35 (37.2%; 95% CI: 27.4-47.0%) did not receive nevirapine prophylaxis. Twenty-six (27.7%) of these women arrived fully dilated and 9 (9.5%) were not given the drug by the midwives. Among the 59 HIV-infected pregnant women who received nevirapine before delivery, 33 (55.9%, 95% CI: 43.2-68.6%) received the drug at the start of uterine contractions and 24 (40.7%; 95% CI: 28.2-53.2%) did not receive nevirapine within the recommended time before delivery. Two women (3.4%) received nevirapine, but this was not written in the logbook. Overall, among the 101 newborns, all children received a single-dose nevirapine: 48 (47.5%; 95% CI: 37.8-57.2%) of the 101 newborns received nevirapine in the 24-72 hr following birth and 52 (51.5%; 95% CI: 41.8-61.2%) just after birth when their mother did not receive nevirapine. Even for a protocol as simple as HIV prophylaxis with a single-dose nevirapine, the application in African rural areas encounters field difficulties. Further simplified procedures and health care re-organization are still needed to guarantee a full Prevention of Mother to Child Transmission coverage for every HIV pregnant woman in Africa.

The AIDS epidemic has focused attention on the constraints and deficiencies present in many blood transfusion services in the developing world. We discuss a variety of options for reducing transfusion-related HIV transmission, and suggest how new transfusion strategies may be implemented. We show that a transfusion service cannot rely solely on the screening of donor blood for anti-HIV antibodies and that a more comprehensive approach is needed. Important components of this approach include donor selection and improved clinical practice, in which blood and blood products are prescribed only when really necessary.

Background: Although transmission of human immunodeficiency virus type 1 (HIV-1) from mother to infant has been well documented during pregnancy and delivery, little is known about the possible transmission of HIV-1 during the postnatal period., Methods: We conducted a prospective cohort study in Kigali, Rwanda, of 212 mother-infant pairs who were seronegative for HIV-1 at delivery. All the infants were breast-fed. The subjects were followed at three-month intervals, with Western blot assays for antibodies to HIV-1 and testing of mononuclear cells by a double polymerase chain reaction (PCR) using three sets of primers. To evaluate potential risk factors, each mother who seroconverted was matched with three seronegative control women., Results: After a mean follow-up of 16.6 months, 16 of the 212 mothers became seropositive for HIV-1. Of their 16 infants, 9 became seropositive. One infant was excluded from the analysis because of a positive test by PCR on the blood sample obtained at birth. Postnatal seroconversion to HIV-1 occurred in four of the five infants born to the mothers who seroconverted during the first 3 months post partum, and in four infants of the 10 mothers who seroconverted between month 4 and month 21. In all cases, the infant seroconverted during the same three-month period as the mother. The main risk factor for maternal seroconversion was being single., Conclusions: HIV-1 infection can be transmitted from mothers to infants during the postnatal period. Colostrum and breast milk may be efficient routes for the transmission of HIV-1 from recently infected mothers to their infants.