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hypothesis but rather suggest that asymptomatic hyperlactatemia could be an artefact of blood collection in this
neonatal context and is not a reliable marker for the identification of mitochondrial toxicity under our field
conditions (Ekouévi, IAS 2003, Paris, France).
In conclusion; The ANRS Ditrame Plus project has shown the field efficacy of two news ARV regimens as
compared to ZDV alone. However the high frequency of NVP mutation must be taken into account in the
proposition of new recommendations of ARV use for PMTCT. Several investigations are required to identify
quickly alternatives to NVPsd containing PMTCT regimens. We suggest also that the best option to prevent
MTCT is to initiate HAART as soon as possible during pregnancy for HIV-infected pregnant women with
indication for ARV treatment. The community mobilization and the struggle against stigmatization are vital to
increase uptake of the PMTCT intervention in Africa. Finally, the prevention and control of the risk of postnatal
transmission should complement the very effective peripartum interventions that can now be recommended.
Keys words: Mother-to-child transmission, HIV, Antiretroviral prophylaxis, Africa, Resistance,
Nevirapine, Lactate, Uptake, Infant, ANRS