Perinatal Transmission of the Human Immunodeficiency Virus Type 1 to Infants of Seropositive Women in Zaire

Robert W. Ryder, Wato Nsa, Susan E. Hassig, Frieda Behets, Mark Rayfield, Bayende Ekungola, Ann M. Nelson, Utshudi Mulenda, Henry Francis, Kashamuka Mwandagalirwa, Farzin Davachi, Martha Rogers, Nzila Nzilambi, Alan Greenberg, Jonathan Mann, Thomas C. Quinn, Peter Piot, James W. Curran

Research output: Contribution to journalArticlepeer-review

Abstract

To examine perinatal transmission of the human immunodeficiency virus type 1 (HIV-1) in Zaire, we screened 8108 women who gave birth at one of two Kinshasa hospitals that serve populations of markedly different socioeconomic status. For up to one year, we followed the 475 infants of the 466 seropositive women (5.8 percent of those screened) and the 616 infants of 606 seronegative women matched for age, parity, and hospital. On the basis of clinical criteria, 85 of the seropositive women (18 percent) had the acquired immunodeficiency syndrome (AIDS). The infants of seropositive mothers, as compared with those of seronegative mothers, were more frequently premature, had lower birth weights, and had a higher death rate in the first 28 days (6.2 vs. 1.2 percent; P<0.0001). The patterns were similar at the two hospitals. Twenty-one percent of the cultures for HIV-1 of 92 randomly selected cord-blood samples from infants of seropositive women were positive. T4-cell counts were performed in 37 seropositive women, and cord blood from their infants was cultured. The cultures were positive in the infants of 6 of the 18 women with antepartum T4 counts of 400 or fewer cells per cubic millimeter, as compared with none of the infants of the 19 women with more than 400 T4 cells per cubic millimeter (P = 0.02). One year later, 21 percent of the infants of the seropositive mothers had died as compared with 3.8 percent of the control infants (P<0.001), and 7.9 percent of their surviving infants had AIDS. We conclude that the mortality rates among children of seropositive mothers are high regardless of socioeconomic status, and that perinatal transmission of HIV-1 has a major adverse effect on infant survival in Kinshasa. IN Europe and North America relatively few women of childbearing age are infected with human immunodeficiency virus type 1 (HIV-1). As a result, perinatal transmission accounts for only a small proportion of the new cases of HIV-1 infection.1,2 By contrast, some reports of HIV-1 seroprevalence among women of childbearing age in Central and East Africa give rates as high as 10 percent.3 4 5 6 In Kinshasa, Zaire, 5 to 7 percent of women attending antenatal clinics have been shown to be seropositive for HIV-1.3 The effect of these high rates of infection on infant and childhood morbidity and mortality has not been…

Original languageEnglish (US)
Pages (from-to)1637-1642
Number of pages6
JournalNew England Journal of Medicine
Volume320
Issue number25
DOIs
StatePublished - Jun 22 1989
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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