Update

Transmission of HIV-1 from mother to child

Research output: Contribution to journalArticle

Abstract

Mother-to-child transmission near the time of birth is the primary route of HIV-1 infection among infants and young children. Throughout the world, 1000 babies a day become infected with HIV, and cumulative global estimates are that 3 million children have been infected since the HIV pandemic began. Although major advances have been made in reducing mother-to-child transmission of HIV-1 in the USA and Europe through the use of an intensive regimen of zidovudine, many research questions remain unresolved. These include (1) viral and host characteristics which hinder or facilitate perinatal HIV transmission (i.e. the role played by viral load, the placenta and obstetric risk factors); (2) the proportion of transmission occurring in utero, intrapartum or during the breast feeding period; and (3) the mode of action of the successful zidovudine regimen. Studies published within the past year have shed light on several of these research topics. In 1996-1997 a number of important studies were published which support a general correlation between maternal viral load and infant HIV infection. The most recent studies do not, however, support the theory that there is a threshold below which transmission cannot occur, and also indicate that zidovudine, given according to the US Public Health Service guidelines, can significantly reduce the risk of transmission across all levels of maternal viral load. Analyses of viral load data from the successful clinical trial with zidovudine (AIDS Clinical Trial Group 076) suggest that its primary action is not by reducing the viral load, and raise the possibility that administering antiretroviral prophylaxis to the infant at the time of highest exposure may be another reason for the reduction in transmission. Obstetric risk factors for mother-to-child HIV transmission have been evaluated in several large cohort studies. A duration of membrane rupture of more than 4 h, and procedures such as amniocentesis, preterm labor, and the presence of sexually transmitted diseases during pregnancy were found to be significant risk factors. Still unresolved is the potential protective effect of cesarean section in reducing the risk of transmission. Likewise, the role played by the placenta in preventing or facilitating perinatal transmission is not well understood, and requires further research. This year did see the publication of consistent findings from diverse geopraphical regions regarding the probable timing of perinatal HIV transmission. On the basis of the timing of the first infant positive polymerase chain reaction or culture, most transmission would appear to occur around the intrapartum or very]ate prenatal period, and only approximately 12-14% is related to breast feeding. These advances should help focus and refine future research efforts to reduce mother-to-child HIV transmission worldwide.

Original languageEnglish (US)
Pages (from-to)496-501
Number of pages6
JournalCurrent Opinion in Infectious Diseases
Volume10
Issue number6
StatePublished - 1997

Fingerprint

HIV-1
Viral Load
Zidovudine
Mothers
HIV
Breast Feeding
Placenta
Obstetrics
HIV Infections
Research
Clinical Trials
Amniocentesis
United States Public Health Service
Premature Obstetric Labor
Pandemics
Sexually Transmitted Diseases
Cesarean Section
Publications
Rupture
Acquired Immunodeficiency Syndrome

ASJC Scopus subject areas

  • Immunology
  • Microbiology (medical)

Cite this

Update : Transmission of HIV-1 from mother to child. / Fowler, Mary Glenn.

In: Current Opinion in Infectious Diseases, Vol. 10, No. 6, 1997, p. 496-501.

Research output: Contribution to journalArticle

@article{3ef16160b6b74950bf1492dc90be18cb,
title = "Update: Transmission of HIV-1 from mother to child",
abstract = "Mother-to-child transmission near the time of birth is the primary route of HIV-1 infection among infants and young children. Throughout the world, 1000 babies a day become infected with HIV, and cumulative global estimates are that 3 million children have been infected since the HIV pandemic began. Although major advances have been made in reducing mother-to-child transmission of HIV-1 in the USA and Europe through the use of an intensive regimen of zidovudine, many research questions remain unresolved. These include (1) viral and host characteristics which hinder or facilitate perinatal HIV transmission (i.e. the role played by viral load, the placenta and obstetric risk factors); (2) the proportion of transmission occurring in utero, intrapartum or during the breast feeding period; and (3) the mode of action of the successful zidovudine regimen. Studies published within the past year have shed light on several of these research topics. In 1996-1997 a number of important studies were published which support a general correlation between maternal viral load and infant HIV infection. The most recent studies do not, however, support the theory that there is a threshold below which transmission cannot occur, and also indicate that zidovudine, given according to the US Public Health Service guidelines, can significantly reduce the risk of transmission across all levels of maternal viral load. Analyses of viral load data from the successful clinical trial with zidovudine (AIDS Clinical Trial Group 076) suggest that its primary action is not by reducing the viral load, and raise the possibility that administering antiretroviral prophylaxis to the infant at the time of highest exposure may be another reason for the reduction in transmission. Obstetric risk factors for mother-to-child HIV transmission have been evaluated in several large cohort studies. A duration of membrane rupture of more than 4 h, and procedures such as amniocentesis, preterm labor, and the presence of sexually transmitted diseases during pregnancy were found to be significant risk factors. Still unresolved is the potential protective effect of cesarean section in reducing the risk of transmission. Likewise, the role played by the placenta in preventing or facilitating perinatal transmission is not well understood, and requires further research. This year did see the publication of consistent findings from diverse geopraphical regions regarding the probable timing of perinatal HIV transmission. On the basis of the timing of the first infant positive polymerase chain reaction or culture, most transmission would appear to occur around the intrapartum or very]ate prenatal period, and only approximately 12-14{\%} is related to breast feeding. These advances should help focus and refine future research efforts to reduce mother-to-child HIV transmission worldwide.",
author = "Fowler, {Mary Glenn}",
year = "1997",
language = "English (US)",
volume = "10",
pages = "496--501",
journal = "Current Opinion in Infectious Diseases",
issn = "0951-7375",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Update

T2 - Transmission of HIV-1 from mother to child

AU - Fowler, Mary Glenn

PY - 1997

Y1 - 1997

N2 - Mother-to-child transmission near the time of birth is the primary route of HIV-1 infection among infants and young children. Throughout the world, 1000 babies a day become infected with HIV, and cumulative global estimates are that 3 million children have been infected since the HIV pandemic began. Although major advances have been made in reducing mother-to-child transmission of HIV-1 in the USA and Europe through the use of an intensive regimen of zidovudine, many research questions remain unresolved. These include (1) viral and host characteristics which hinder or facilitate perinatal HIV transmission (i.e. the role played by viral load, the placenta and obstetric risk factors); (2) the proportion of transmission occurring in utero, intrapartum or during the breast feeding period; and (3) the mode of action of the successful zidovudine regimen. Studies published within the past year have shed light on several of these research topics. In 1996-1997 a number of important studies were published which support a general correlation between maternal viral load and infant HIV infection. The most recent studies do not, however, support the theory that there is a threshold below which transmission cannot occur, and also indicate that zidovudine, given according to the US Public Health Service guidelines, can significantly reduce the risk of transmission across all levels of maternal viral load. Analyses of viral load data from the successful clinical trial with zidovudine (AIDS Clinical Trial Group 076) suggest that its primary action is not by reducing the viral load, and raise the possibility that administering antiretroviral prophylaxis to the infant at the time of highest exposure may be another reason for the reduction in transmission. Obstetric risk factors for mother-to-child HIV transmission have been evaluated in several large cohort studies. A duration of membrane rupture of more than 4 h, and procedures such as amniocentesis, preterm labor, and the presence of sexually transmitted diseases during pregnancy were found to be significant risk factors. Still unresolved is the potential protective effect of cesarean section in reducing the risk of transmission. Likewise, the role played by the placenta in preventing or facilitating perinatal transmission is not well understood, and requires further research. This year did see the publication of consistent findings from diverse geopraphical regions regarding the probable timing of perinatal HIV transmission. On the basis of the timing of the first infant positive polymerase chain reaction or culture, most transmission would appear to occur around the intrapartum or very]ate prenatal period, and only approximately 12-14% is related to breast feeding. These advances should help focus and refine future research efforts to reduce mother-to-child HIV transmission worldwide.

AB - Mother-to-child transmission near the time of birth is the primary route of HIV-1 infection among infants and young children. Throughout the world, 1000 babies a day become infected with HIV, and cumulative global estimates are that 3 million children have been infected since the HIV pandemic began. Although major advances have been made in reducing mother-to-child transmission of HIV-1 in the USA and Europe through the use of an intensive regimen of zidovudine, many research questions remain unresolved. These include (1) viral and host characteristics which hinder or facilitate perinatal HIV transmission (i.e. the role played by viral load, the placenta and obstetric risk factors); (2) the proportion of transmission occurring in utero, intrapartum or during the breast feeding period; and (3) the mode of action of the successful zidovudine regimen. Studies published within the past year have shed light on several of these research topics. In 1996-1997 a number of important studies were published which support a general correlation between maternal viral load and infant HIV infection. The most recent studies do not, however, support the theory that there is a threshold below which transmission cannot occur, and also indicate that zidovudine, given according to the US Public Health Service guidelines, can significantly reduce the risk of transmission across all levels of maternal viral load. Analyses of viral load data from the successful clinical trial with zidovudine (AIDS Clinical Trial Group 076) suggest that its primary action is not by reducing the viral load, and raise the possibility that administering antiretroviral prophylaxis to the infant at the time of highest exposure may be another reason for the reduction in transmission. Obstetric risk factors for mother-to-child HIV transmission have been evaluated in several large cohort studies. A duration of membrane rupture of more than 4 h, and procedures such as amniocentesis, preterm labor, and the presence of sexually transmitted diseases during pregnancy were found to be significant risk factors. Still unresolved is the potential protective effect of cesarean section in reducing the risk of transmission. Likewise, the role played by the placenta in preventing or facilitating perinatal transmission is not well understood, and requires further research. This year did see the publication of consistent findings from diverse geopraphical regions regarding the probable timing of perinatal HIV transmission. On the basis of the timing of the first infant positive polymerase chain reaction or culture, most transmission would appear to occur around the intrapartum or very]ate prenatal period, and only approximately 12-14% is related to breast feeding. These advances should help focus and refine future research efforts to reduce mother-to-child HIV transmission worldwide.

UR - http://www.scopus.com/inward/record.url?scp=0030862443&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030862443&partnerID=8YFLogxK

M3 - Article

VL - 10

SP - 496

EP - 501

JO - Current Opinion in Infectious Diseases

JF - Current Opinion in Infectious Diseases

SN - 0951-7375

IS - 6

ER -