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Mother-to-child transmission of HIV
1Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque 87131-5267, USA.
Insights
Preventing mother-to-child HIV-1 transmission is crucial, especially during childbirth and breastfeeding. Research identifies factors influencing transmission and informs interventions for infected children globally.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- The first pediatric Human Immunodeficiency Virus type 1 (HIV-1) infections were identified in 1983.
- The global HIV epidemic significantly impacts child health and survival, with vertical transmission being the primary route of infection.
- Intrapartum transmission represents a critical window for prevention strategies.
Purpose of the Study:
- To elucidate factors influencing mother-to-infant HIV-1 transmission.
- To understand the natural history of HIV disease in perinatally infected children.
- To identify feasible interventions for reducing pediatric HIV in developing nations.
Main Methods:
- Epidemiologic studies were conducted to analyze transmission risks.
- Immunologic, virologic, and behavioral factors were investigated.
- Data on HIV disease progression in infected children were analyzed.
Main Results:
- Vertical transmission, particularly during the intrapartum period and through breastfeeding, is a major concern.
- Maternal viral load alone does not fully explain HIV-1 vertical transmission.
- Numerous factors influence the risk of mother-to-infant HIV-1 transmission.
Conclusions:
- Counseling HIV-infected women on risk reduction is essential.
- Effective and feasible interventions are needed for developing countries with high HIV burdens.
- Further research is required to optimize prevention of mother-to-child HIV transmission.
Abstract:
The first children with HIV-1 infection were described in 1983. As of 1998, the global HIV epidemic is having a profound impact on the health and survival of children. Almost all HIV infections among young children are due to vertical transmission, and the intrapartum period appears to provide us with a crucial window of opportunity for prevention. Postnatal transmission through breastfeeding also contributes an estimated one third to one half of vertical transmission worldwide. Carefully conducted epidemiologic studies are elucidating the immunologic, virologic, and behavioral factors affecting the risk of HIV-1 transmission from mother to infant and the natural history of HIV disease in perinatally infected children. Transmission of HIV-1 is influenced by many factors, and a high maternal viral load is insufficient to fully explain vertical transmission of HIV-1. Pediatricians and other providers should counsel HIV-infected women about the means available to decrease the risk of HIV transmission to the infant. However, the majority of HIV-infected children are born in the developing world, and a crucial challenge is to identify safe and effective interventions that are feasible in those countries with the most significant HIV burden.