SynthesisThe lancet. HIV2025
Probability of vertical HIV transmission: a systematic review and meta-regression.
Synthesis in The lancet. HIV, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 14 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed.
- Bone health across the lifespan in African populations affected by HIV.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2026Article
- Systematic estimates of global causes of neonatal and under 5 mortality in 2000-24: secondary data analysis using bayesian multinomial logistic regression.BMJ (Clinical research ed.) · 2026Article
- Timely and Efficient Infant Diagnosis Is Required to End AIDS in Children.Journal of the International AIDS Society · 2026Article
- Drivers of Vertical HIV Transmission in Sub-Saharan Africa and the Impact and Cost-Effectiveness of Targeted and Universal Lenacapavir Pre-Exposure Prophylaxis.Journal of the International AIDS Society · 2026Article
- HIV-1 drug resistance among pregnant and breastfeeding mothers and its association with paediatric HIV infections in the Dolutegravir era in Uganda.The Journal of antimicrobial chemotherapy · 2026Article
- BRIDGES: a patient-centered, community-informed HIV doula program that supports infant feeding choice among Hispanic and Caribbean families: a study protocol.Frontiers in reproductive health · 2026Article
- How antiretroviral data cleaning reshaped Mozambique's progress to reaching HIV epidemic control.PloS one · 2026Article
- "It's exactly what's needed": a call to action for breastmilk studies of vertical HIV transmission in high-income countries.Frontiers in reproductive health · 2026Article
- Understanding practices of lactation and infant feeding together with women with HIV: the UPLIFT observational study protocol.Frontiers in reproductive health · 2026Article
- Maternal Antiretroviral Use and the Risk of Prematurity and Low Birth Weight in Perinatally HIV-Exposed Children-7 Years' Experience in Two Romanian Centers.Medicina (Kaunas, Lithuania) · 2026Observational
- Characterizing immune activation in HIV-exposed but uninfected infants in the first year of life.Frontiers in immunology · 2026Observational
- From HIV to SARS-CoV-2 associated neurological disorder ("HAND" to "SAND"): Viral infection as a "time-bomb" for the aging brain.Neuroscience applied · 2026Review
- The time is now to use the tools we have to end AIDS in children.Journal of the International AIDS Society · 2025Review
- Viral Load Suppression Associated With Undisclosed HIV Status Among Adolescents Aged 10 to 19 Years Living With HIV in Low- and Middle-Income Countries: Protocol for a Scoping Review.JMIR research protocols · 2025Article
Corrections and comments
- Erratum issued
- Update of
Authors and funding
15 authors.
Funding
Abstract
backgroundEliminating HIV vertical transmission is a global priority and monitored by estimating paediatric HIV infections with the UNAIDS-supported Spectrum AIDS Impact Module (Spectrum-AIM). Recent innovations in antiretroviral therapy (ART) service-delivery models and first-line regimens aimed to reduce vertical transmission probabilities. We did a systematic review and meta-analysis to estimate vertical transmission probabilities by maternal immunological and treatment status.
methodsIn this systematic review and meta-regression, we combined an updated systematic review with previous data in meta-regression models to estimate vertical transmission probabilities and determinants. We searched PubMed, Embase, the Global Health Database, WHO Global Index Medicus, CINAHL Complete, and Cochrane CENTRAL for peer-reviewed English-language studies from all regions published between Jan 1, 2018 and Feb 8, 2024, with search term domains mentioning "HIV", "transmission", "perinatal", and "breastfeeding periods", and "infants born to women living with HIV" or related terms from randomised trials, cohort studies, or observational studies. Four meta-regression models estimated vertical transmission probabilities. We assessed model sensitivity and compared estimates to Spectrum-AIM's previous results. Finally, we fit a meta-regression model to assess the association of ART class and initiation timing on viral load suppression (VLS) at delivery.
findingsOf 12 588 potential studies, we identified 24 new studies, which along with the 86 from previous reviews yielded 110 total studies included in meta-regression analysis. For women not receiving ART, higher CD4 count was associated with lower odds of perinatal vertical transmission (odds ratio [OR] 0·80, 95% CI 0·75-0·84, per 100 cells per μL increase). For pregnant women on ART, each additional week on ART before delivery reduced odds of vertical transmission by 5·6% (95% CI 4·2-7·0). The OR of perinatal vertical transmission among pregnant women initiating integrase inhibitor-based ART 20 weeks before delivery was 0·36 (0·14-0·94) compared with those initiating non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART. This association was confounded by study region. Odds of VLS were lower when ART was initiated late in pregnancy (OR 0·37, 0·21-0·68) for the reference regimen [NNRTI]), without significant difference by ART regimen.
interpretationVertical transmission probability varies by maternal immunological stage, treatment regimen, and timing of treatment initiation. These estimates have been incorporated into Spectrum-AIM for UNAIDS 2025 HIV estimates. Earlier ART initiation is associated with higher odds of VLS at delivery. Further evidence is needed on the effects of recent ART innovations on vertical transmission outcomes.
fundingNational Institutes of Health, UNAIDS, and UK Research and Innovation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.