VIH y SARS-CoV-2: aspectos a considerar para enfrentar esta nueva pandemia / HIV and SARS-CoV-2: points to consider to face this new pandemic

En diciembre de 2019 una nueva especie de ß-coronavirus causante de neumonía fue identificada en la ciudad China de Wuhan, el cual posteriormente fue denominado SARS-CoV-2. Este virus de ácido ribonucleico presenta ciertas similitudes con otros virus del mismo material genético, dentro de ellos se ha visto que la infección por virus de la inmunodeficiencia humana se asemeja en diversos aspectos a la infección por SARS-CoV-2. En este comentario presentamos algunas de las similitudes virológicas, inmunológicas, clínicas y farmacológicas entre estos dos virus, las cuales podrían permitirnos entender de mejor manera la inmunopatogenia de COVID-19, así como también tomar algunas decisiones en cuanto al manejo antiviral.

In December 2019, a new species of pneumonia-causing betacoronavirus was identified in Wuhan, China, which was later identified as SARS-CoV-2. This RNA virus presents certain similarities with other viruses of the same genetic material. It has been seen that infection by human immunodeficiency virus resembles the infection by SARS-CoV-2 in various aspects. In this comment, we present some of the virological, immunological, clinical, and pharmacological similarities between HIV and SARS-CoV-2, which could allow us to understand the immunopathogenesis of COVID-19 better, as well as make some decisions in regarding antiviral management.

Development and validation of a simple and rapid way to generate low volume of plasma to be used in point-of-care HIV virus load technologies

ABSTRACT A new point-of-care HIV viral load, mPIMA HIV-1/2 VL, Abbott, USA, has been recently developed. This point-of-care viral load requires no skilled person to run and uses a small plasma volume (50 µL). However, obtaining 50 µL of plasma can be a challenge in limited resource settings. We validated a simple and easy method to obtain enough amount of plasma to run a point-of-care viral load. The study utilized 149 specimens from patients failing antiretroviral therapy. At least 250 µL of whole blood was collected in a microtube/EDTA from fingerstick (fs-plasma) and immediately centrifuged. Parallel collection of venous blood to obtain plasma (vp-plasma) was used to compare performance in a point-of-care viral load assay and in methodology used in centralized laboratories Abbott M2000, Abbott, USA. The procedure for plasma collection takes less than 10 min and in 94% of the cases only one fingerstick was sufficient to collect at least 250 µL of blood. The Pearson correlation coefficient value for vp-plasma versus fs-plasma ran on mPIMA was 0.990. The Bland-Altman mean difference (md) for this comparison were virtually zero (md = −0.001) with limits of agreement between −0.225 and 0.223. In addition, the Pearson correlation coefficient value for fs-plasma in mPIMA versus vp-plasma in Abbott M2000 was 0.948 for values above the mPIMA limit of quantification (LoQ; from 800 to 1,000,000 copies/mL). These results validate this simple plasma isolation method capable to be implemented in low resource countries where point-of-care decentralization is deeply needed.

Epidemiología molecular de la criptococosis en un Hospital de enfermedades infecciosas de la Ciudad de Buenos Aires: análisis de 25 años / Molecular epidemiology of cryptococcosis in an infectious diseases hospital from the city of Buenos Aires: A 25 years experience

La criptococosis es una micosis grave de distribución universal, que afecta principalmente a huéspedes inmunocomprometidos. Es una de las principales causas de morbilidad y mortalidad en los pacientes infectados con el virus de la inmunodeficiencia humana (HIV). Provoca al menos 620 000 muertes al año, representando entre el 13% al 44% de la mortalidad en pacientes HIV positivos según datos de cohortes correspondientes a países en desarrollo. (1, 2) La letalidad de la criptococosis meníngea en estudios de Argentina y Brasil muestra valores que van desde el 26% hasta el 63%. El complejo Cryptococcus neoformans/ Cryptococcus gattii, es el responsable de esta enfermedad. Existen alrededor de 70 especies pero solo dos de ellas son patógenas para el hombre: C. neoformans y C. gattii. Se reconocen 8 genotipos de este complejo, C. neoformans: VNI y VNII (C. neoformans var. grubii), VNIII (C. neoformans híbrido intervariedad AD), VNIV (C. neoformans var. neoformans) y C. gattii: genotipos VGI, VGII, VGIII y VGIV. Se han descripto híbridos interespecie VNIV/VGI, VNI/VGI, VNI/VGII. Se estudiaron 207 aislamientos de Cryptococcus, elegidos aleatoriamente, de un total de 2593 pacientes con diagnóstico de criptococosis diseminada. A los mismos se les realizó la genotipificación mediante una PCR-RFLP del gen URA5, y posterior digestión enzimática con enzimas Sau96I y HhaI. De las 207 cepas estudiadas, 174 fueron VNI (84,05%), 14 VNII (6,76%), 10 VNIII (4,83%), 2 VNIV (0,97%), 3 VGI (1,45%), 3 VGII de (1,45%) y 1 VGIII (0,49%).

Cryptococcosis is a severe worldwide mycosis, which mainly affects immunocompromised hosts and is a major cause of morbidity and mortality in HIV-infected patients. It causes 620,000 annual deaths, accounting for 13-44 % of mortality in HIV-positive individuals in developing countries. Mortality rates of meningeal cryptococcosis in studies from Argentina and Brazil go from 26 to 63 %. Cryptococcus neoformans/Cryptococcus gattii is the species complex responsible for this disease. There are about 70 species, however, only two are human pathogens: C. neoformans and C. gattii. C. neoformans genotypes are VNI and VNII (C. neoformans var. grubii), VNIII (C. neoformans intervariety hybrid AD), VNIV (C. neoformans var. neoformans). C. gattii genotypes are VGI, VGII, VGIII and VGIV. Interspecies hybrids were described: VNIV/VGI, VNI/VGI, VNI/ VGII. A total of 207 Cryptococcus isolates were randomly selected from 2593 patients with diagnosis of disseminated cryptococcosis. Genotyping was performed by PCRRFLP of UR A5 gene with restriction enzyme digestion using Sau96I and HhaI enzymes. Among the 207 studied isolates, 174 resulted VNI (84.05%), 14 VNII (6.76%), 10 VNIII (4.83%), 2 VNIV (0.97%), 3 VGI (1.45%), 3 VGII (1.45%) and 1 VGIII (0.49%).

Avaliação da correlação de sorologia e teste de ácido nucleico em doadores de sangue reagentes para o Vírus da Imunodeficiência Humana / Evaluation of the correlation of serology and nucleic acid testing in Anti-HIV reagent blood donors

Introdução: As transfusões sanguíneas começaram a ser realizadas no Brasil no século XX como forma de tratamento terapêutico. Com a descoberta do vírus HIV, a segurança do sangue doado passou a ser prioritária. Assim, candidatos à doação de sangue são submetidos a uma triagem clínica e sorológica, além do teste de ácido nucleico (NAT), obrigatório desde 2014 nos bancos de sangue. Métodos: Estudo retrospectivo através da análise de dados dos doadores de sangue de um Serviço de Hemoterapia em Porto Alegre/RS, nos anos de 2015 a 2017. Avaliando resultados sorológicos e da técnica NAT para HIV. Resultados: Das 28.625 amostras de usuários do serviço de hemoterapia, 41 (0,14%) foram reagentes para o HIV e 21 (0,07%) foram reagente para o teste NAT. Estes dados demonstram uma reatividade duas vezes maior nas amostras de bolsas testadas sorologicamente quando comparadas com a metodologia utilizada no NAT. Conclusão: O avanço científico e tecnológico tem auxiliado no que se refere a redução dos riscos de transmissão de doenças infecto-contagiosa por transfusão sanguínea. O teste NAT teve um acréscimo significativo na pesquisa dos vírus para a segurança na liberação de hemocompoentes. O teste foi introduzido nas rotinas de banco de sangue no intuito de reduzir o período de janela imunológica quando comparado aos testes sorológicos, fato este não observado nos anos de coleta de dados no Serviço de Hemoterapia referido neste estudo. (AU)

Introduction: Blood transfusions began to be performed in Brazil in the twentieth century as a form of therapeutic treatment. With the discovery of the HIV, the safety of donated blood became a priority. Therefore, candidates for blood donation are subjected to clinical and serological screening, in addition to the nucleic acid test (NAT), which has been mandatory since 2014 in blood banks. Methods: We conducted a retrospective study using data from blood donors at one hemotherapy service in Porto Alegre, state of Rio Grande do Sul, from 2015 to 2017. Serological and NAT results for HIV were evaluated. Results: Of the 28,625 samples of users of the hemotherapy service, 41 (0.14%) were HIV reagents and 21 (0.07%) had a reagent result for the NAT test. These data demonstrate a two-fold higher reactivity in the samples of serologically tested units as compared to the methodology used in NAT. Conclusions: Studies with different time periods are needed to further explain this association. The NAT test had a significant increase in the search for viruses and the safety in the release of blood components. The test was introduced in the blood bank routines in order to reduce the window period when compared to serological tests, a fact that was not observed in the years of data collection in the hemotherapy service referred to in this study. (AU)

Prevalencia del virus de la inmunodeficiencia humana, virus de la hepatitis B y Treponema pallidum en reclusos del Centro de Detención Preventiva de Arica, Chile / Prevalence of HIV, hepatitis B virus and Treponema pallidum in inmates in the Preventive Detention Center of Arica, Chile

Resumen Introducción: Los grupos de riesgo para las infecciones de transmisión sexual (ITS) son trabajadores sexuales, drogadictos, la población joven de inicio sexual precoz, así como la población penal. Objetivo: Determinar la prevalencia de infección por virus de inmunodeficiencia humana (VIH), Treponema pallidum y virus de hepatitis B (VHB) en reclusos (hombres) del Centro de Detención Preventiva (CDP) de Arica. Material y Métodos: El estudio se efectuó en 140 reclusos, con consentimiento informado. Se realizó encuesta epidemiológica y toma de muestra sanguínea. Los exámenes positivos se enviaron al Hospital Regional de Arica para confirmación y posteriormente al Instituto de Salud Pública. Resultados: La prevalencia de ITS fue de 13,6%. La mayor frecuencia se observó en VDRL positivos (7,1%), seguido por infección por VIH (5,7%) y VHB (2,9%). Por edad, la mayor frecuencia (57,9%) se presentó en individuos bajo 31 años. El 63,2% se encontraban en situación de hacinamiento, en 42,1% la edad de inicio de la actividad sexual fue antes de los 15 años y 94,7% declaró ser consumidor de drogas. Conclusiones: El estudio reafirma los factores predisponentes a la transmisión de las ITS, como edad, inicio sexual precoz, consumo de drogas y hacinamiento, destacando que las prisiones son ambientes altamente vulnerables, donde la sobrepoblación, condición sexual, inicio sexual precoz, alto consumo de drogas y la carente visita conyugal proporcionan un contexto epidemiológico favorable para el incremento de ITS.

Background: The risk groups for sexual transmitted diseases (STDs) are sex workers, drug addicts, young people in early sexual initiation, and population in prison. Aim: To determine the prevalence of HIV, Treponema pallidum and hepatitis B Virus (HBV) in male inmates at the Preventive Detention Center (CDP) of Arica. Methods: The study was conducted in 140 inmates, with informed consent. Epidemiological survey and blood sampling was conducted. The positive tests were sent to the Hospital Regional of Arica for confirmation and the National Reference Laboratory for confirmation. Results: STD prevalence was 13.6%. The most prevalent was VDRL positive (7.1%) followed by HIV infection (5.7%) and HBV (2.9%). The highest rate (57.9%) occurred in individuals under 31 years old. 63.2% were in an overcrowded situation, 42.1% of cases corresponded to those whose age of sexual activity onset of was before age 15 and 94.7% used drugs. Conclusions: The study reasserts the predisposing factors for the transmission of STDs as age, early sexual debut, drug abuse and overcrowding, noting that prisons are highly vulnerable environments where overcrowding, sexual condition, early sexual initiation, high drug abuse and the lacking spouses visits provide an epidemiological context favorable for increased STD.

simple and rapid method for the detection of HIV-1/HCV in co-infected patients

Due to some limitations of serological methods in diagnosis of patients infected with HIV-1 [human immunodeficiency virus] and HCV [hepatitis C virus], it is profoundly important to use molecular methods for the detecting of these infectious agents. However, the most significant problems are the exorbitant cost of these methods and the need of a thermocycler which is an expensive instrument. The current research recruits a multiplex nucleic acid sequence base amplification [NASBA] in order to simultaneously detect HIV-1 and HCV genomes in patients' plasma samples. Sensitivity and specificity of this method have been evaluated using clinical samples. A multiplex NASBA assay for simultaneous detection of HCV and HIV-1 by the use of specific primers were designed and validated. A well-conserved region in the HIV-1 pol gene and 5'-NCR of HCV genome were used. A total of 40 samples of HIV-1 [20 samples] and HCV [20 samples] were used in the NASBA assay. The specificity and sensitivity of the assay were evaluated. Our results have demonstrated that the primers used in the assay had no interrelation with each other and other possible interfering agents in the assay. The analytical sensitivity of the assay for both HIV-1 and HCV was determined to be 1000 copies/mL and the clinical sensitivity and specificity were 93.3% and 100%, respectively. By exploiting this multiplex NASBA assay, it is possible to detect HIV-1 and HCV infection/co-infection in patients' plasma with a suitable sensitivity and specificity. Furthermore, due to its simplicity and multiplexing feature, it could be used in limited access laboratories in a cost-effective manner.

Teste de amplificação de ácidos nucléicos (NAT) para detecção dos vírus da imunodeficiência humana (HIV) e da hepatite (HCV) / Nucleic acid amplification test (NAT) for the detection of human immunodeficiency virus (HIV) and hepatitis (HCV)

O NAT é uma tecnologia desenvolvida para a detecção do ácido nucléico do Vírus da Imunodeficiência Humana - HIV e do Vírus da Hepatite C - HCV, em bolsas de sangue destinadas à transfusão. Os testes desenvolvidos estão sendo implantados com o propósito de identificar os ácidos ribonucléicos (RNA) desses vírus previamente aos testes sorológicos convencionais, além de identificá-los em bolsas doadas com níveis de anticorpos indetectáveis pelos testes sorológicos tradicionais, promovendo a redução do período denominado janela imunológica - período compreendido entre o contato com o antígeno hemotransmissível e a produção de anticorpos em níveis detectáveis pelos testes sorológicos atuais. A implementação da tecnologia NAT para triagem em bancos de sangue reduz o risco de transmissão de agentes virais transmissíveis por transfusão, como HIV e HCV, uma vez que é possível a detecção mais precocemente dos antígenos em doações realizadas durante o período posterior a soro-conversão, porém, ainda em janela imunológica para sorologia. Diferentemente do teste de sorologia, o NAT não detecta a presença de anticorpos e sim do material genético do vírus, reduzindo a janela imunológica no caso do HIV de 19-22 dias para 10 dias e HCV de 60 dias para 11 dias. O NAT é complementar a sorologia e não possui a capacidade de substituí-la uma vez que com a progressão da infecção a carga viral tende a ficar em alguns momentos indetectável. Cabe ressaltar que a total garantia de detecção de agentes infecciosos não é proporcionada por nenhum teste utilizado, devido ao período denominado eclipse viral, ou latência, presente nos ciclos do HIV e HCV, não sendo possível detectar a presença de antígenos e nem anticorpos circulantes, uma vez que o vírus apresenta-se com replicação local intracelular e o organismo ainda não produziu anticorpos para o agente infeccioso. O Kit NAT HIV/HCV Brasileiro, desenvolvido com tecnologia totalmente nacional, tem capacidade de processar 96 reações, destas duas são controles negativos, duas controles positivos, ambos amplificam HIV e HCV, e 92 reações que podem ser processadas em minipool de seis amostras, permitindo assim o processamento de 552 amostras em uma única rotina. Caso algum minipool de seis apresente resultado positivo, as seis amostras que o compõem deverão ser processadas em uma próxima rotina separadamente ("single") para identificação da amostra positiva. Com base nos critérios de: expressivo quantitativo de amostras testadas, maior estrutura da rede de serviços públicos no estado e melhor logística e organização, em relação à centralização dos testes sorológicos no Hemocentro Coordenador, o Ministério da Saúde definiu, visando a economicidade e o melhor aproveitamento dos kits produzidos por Bio-Manguinhos, 14 serviços de hemoterapia listados acima como sítios testadores NAT, os quais centralizarão amostras dos demais Estados, com logística de transporte interestadual de amostras NAT oferecido pelo Ministério da Saúde. Para atender os avanços da tecnologia NAT, a fim de garantir maior segurança tranfusional e a realização dos testes no âmbito nacional, a Coordenação Geral de Sangue e Hemoderivados solicitou a inclusão, na tabela de ressarcimento SIA/SUS, dos custos diretos e indiretos do procedimento, excetuando-se o kit NAT para HIV e HVC fornecidos aos centros testadores por Biomanguinhos. Tais custos referem-se a gastos como: energia elétrica, recursos humanos, logística de transporte de amostras e demais insumos necessários a realização do teste. Os membros da CONITEC presentes na reunião do plenário do dia 07/12/2012 deliberaram, por unanimidade, por recomendar a incorporação do procedimento para possibilitar a testagem de amostra de sangue de doadores pelo teste de amplificação de ácidos nucléicos (NAT) para detecção dos vírus da imunodeficiência humana (HIV) e da hepatite C (HCV) no âmbito do Sistema Nacional de Sangue, Componentes e Hemoderivados. A Portaria CTIE-MS N.º 25, de 12 de junho de 2013 - Toma Decisão de incorporar o procedimento para possibilitar a testagem de amostra de sangue de doadores pelo teste de amplificação de ácidos nucleicos (NAT) para detecção dos vírus da imunodeficiência humana (HIV) e da hepatite C (HCV) no âmbito do Sistema Nacional de Sangue, Componentes e Hemoderivados no Sistema Único de Saúde - SUS.

Detection of HIV drug resistance mutations in pregnant women receiving single dose Nevirapine in south India.

Background: Single dose of Nevirapine to prevent mother to child transmission of HIV is the commonest preventive regimen in resource-limited countries. Objectives: The objective of this study was to detect drug-resistant virus after single dose of Nevirapine (sdNVP) provided to delivering HIV seropositive (HIV+ve) women and to evaluate the time taken for its decay. Results: Of the 36 consenting HIV+ve pregnant women enrolled into the study, the mean hemoglobin and total lymphocyte counts were 10.8 g/dl and 1843 cells/mm 3 , respectively. Mean CD4 counts in 64% of women was 363 cells/mm 3 and mean viral load for 16/36 women was 28,143 copies/ml of plasma. Nevirapine-resistance mutations were detected in 28% of women at delivery; using OLA (Oligonucleotide Ligation Assay). K103N mutations were seen in 19.4% of women while the Y181C mutation was seen in 5%. Both the mutations were detected in 2.7% of women. Sequential blood samples collected at delivery, 7-10 days, 6 weeks, 4 months, 6 months and one year postpartum showed that 81% of K103N mutations and 66.7% of Y181C mutations were detected at 6 weeks postpartum . Wild-type virus had replaced the mutants by one year postpartum in all women except one. Conclusion : These observations are relevant for future treatment with antiretroviral therapy in these women for their HIV disease.

Relative frequency of infections among hospitalized injecting drug user-HIV positive patients in Razi hospital, Ahvaz, SW Iran [2001-2003]

Frequency of infections in Injecting Drug Users [IDU] varies in different areas according to socioeconomic and geographic situation as well as Human Immunodeficiency Virus [HIV] infection rate. The present study was performed to determine the frequency of infections in IDU-HIV positive patients. Forty known cases of HIV infected [by positive ELISA and western blot tests] were investigated for various infections in Razi hospital in Ahvaz, South West of Iran during 2001-2003. Medical charts including age, duration of addiction, imprisonment, site of infection, signs and symptoms, laboratory findings, imaging result and echocardiography report were prepared. Data were analyzed in SPSS software by using descriptive statistical methods. Forty IDU-HIV positive male patients with a mean age of 25 +/- 6.3 years were included in this study. More than 50% of patients had a history of imprisonment. Bacterial infection diagnosed in 40% and viral infection in 100%. Three patients died due to mixed infection and AIDS. The obtained rate of infections in IDU-HIV positive in Ahvaz was very higher than expected. Rapid diagnosis of above mentioned infections, appropriate management and treatment can prevent or postpone progressing of AIDS

Prevalence of HBV, HCV and HIV in blood donors at Liaquetpur

To know the prevalence of hepatitis B, hepatitis C and HIV. Observational cross sectional study. Blood Transfusion Center Tehsil Headquarter Hospital Liaquetpur. The data of blood donors from 2001 to 2003. Total blood donors studied were 1426. The prevalence for hepatitis B was 5.96% [CL 4.84%-7.32%] It was 0.07% [CL <0.01% - 0.44%] for HCV and zero for HIV. The prevalence of HBV in males was 6.03% [CL 4.87%-7.45%] while 5.05% [CL 1.91%-11.63%] in females [p=0.6917]. The prevalence in 17-20 years age group was 6.4% [CL 3.92%-10.23%], 5.81% [CL 4.6%-7.33%] in 21-40 years age group and in 41-60 years age group it was 4.35% [CL 1.33%-28.19%] [p=0.9029]. Hepatitis B is common, hepatitis C is an uncommon health problem while HIV is not present in this area

Seroprevalence of human immunodeficiency virus and some AIDS associated opportunistic infections in parts of Northern Nigeria

A total of 620 consenting patients were tested for HIV by rapid Elisa method in three government hospital in Wukari Local government area Taraba State, Nigeria between April 2001 and March 2002. Seropositive subjects were followed up on their subsequent visits to the hospital and using their hospital records to obtain information on their HIV status, other associated and opportunistic infections. A total of 124 [20%] subjects subdivided into males 58 [9.4%] and females 66 [10.6%] of those tested were positive for HIV. While 10 [1.6%] males and 14 [2.3%] females had developed AIDS. Six different infections were identified among the infected subjects including 39 cases of diarrhoea. 31 cases of pulmonary tuberculosis [PTB] 21, cases of oral candidiasis and 19 cases of skin/ soft tissue infections. There were 3 cases of urethral track infection and 24 cases of bronchopneumonia. The productive age group 15-50 years remains mainly the most affected group with the HIV scourge. The negative impact of polygamy, extramarital affairs and lack of women sex right. Empowerment and low level human development on the spread of HIV/AIDS is discussed

Macrófagos infectados por HIV aislados de pacientes HIV+ con carga viral indetectable luego del tratamiento antirretroviral combinado / HIV infected macrophages isolated from HIV+ patients with undetectable viral load undergoing combined antiretroviral treatment

Se desarrolló un método de cultivo prolongado de células mononucleares periféricas, sin estímulo (CMP s/e) que permite la proliferación y diferenciación completa de los macrófagos (M). Con el mismo se demostró la replicación in vitro del HIV en pacientes HIV+ con carga viral negativa luego de más de un año de tratamiento HAART. Las células infectadas siempre fueron M. Utilizando el sistema estándar de co-cultivo con CPM activadas con PHA e IL-2 (CM-PHA) no se habían logrado aislamientos de estos pacientes. Los sobrenadantes (SN) con p24> 65 pg/ml fueron infectivos para target CMP s/e normales, pre-cultivados 6-7 días. Em comparación se utilizaron CMP-PHA. Em CMP predominan los M proliferantes (CD64+, Ki67+) y en CMP-PHA los blastos T (CD3+, Ki67). La expresión de CCR5 fue mayor en CMP s/e que en CMP-PHA. Estas diferencias pueden explicar por qué el sistema CMP s/e es má sensible que CMP-PHA para detectar la infección por HIV en pacientes asintomáticos con carga viral indetectable, con cepas de HIV macrófago trópicas (R5).

Use of nucleic acid testing for blood donor screening of human immunodeficiency virus and hepatitis C virus in the Saudi population

To determine the risk of transfusion associated infection for human immunodeficiency virus and Hepatitis C virus using nucleic acid testing. During March 1998, 400 donor blood samples from the Saudi population that were negative by serology were further tested for human immunodeficiency virus 1 and 2 and Hepatitis C virus using nucleic acid testing. A total of 400 were tested by nucleic acid testing, 381 of these were negative, 4 were indeterminate but were found to be negative on repeat testing and one seronegative sample was found to be positive for Hepatitis C virus. Due to the low prevalence of human immuno-deficiency virus in the Kingdom of Saudi Arabia, nucleic acid testing of blood donors by serology is adequate for screening. But the higher prevalence of Hepatitis C virus and increased risk of transmission would indicate that nucleic acid testing may be warranted for Hepatitis C virus in the near future

Mother-to-Child HIV-1 transmission: state of the art and implications for public policy

During the past five years there have been significant advances in the knowledge of the factors that affect mother-to-infant HIV-1 transmission. Diverse interventions have been designed and proven effective in reducing the risk of such transmission. In reviewing the pivotal literature in such respect implications for public policy are also analyzed. Because of the constant evolution of the interventions, the public policies also need constant revisions. The impact of viral load assessment during pregnancy and its relationship to transmission risks is discussed, as well as the effectiveness of elective Caesarean delivery. The latter has both positive and negative aspects which merit consideration. Newer approaches, such as highly active anti retroviral therapies (HAART), which have shown to decrease the AIDS mortality, have also shown zero transmission in small cohorts. Shorter and cheaper interventions are also somewhat effective and are good alternatives to resource poor countries.