Am J Perinatol 2000; 17(8): 429-436
DOI: 10.1055/s-2000-13458
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

MANAGEMENT OF THE INFANT BORN TO A MOTHER INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS TYPE 1 (HIV-1): CURRENT CONCEPTS

Aracelis D. Fernandez, David F. McNeeley
  • Division of Pediatric Infectious Diseases and Immunology, Weill Medical College of Cornell University, New York, New York
Further Information

Publication History

Publication Date:
31 December 2000 (online)

ABSTRACT

Despite the use of highly active antiretroviral therapy (HAART) and the success of protocol PACTG-076 in decreasing perinatal transmission of HIV infection in many industrialized countries, a total of 5,600,000 new cases of HIV infection were diagnosed worldwide in 1999. Of those cases, more than 10% are children under 15 years of age. The vast majority of pediatric HIV infection is due to perinatal transmission. More than 95% of HIV-infected people live in the developing world. Different studies are currently being conducted with modifications of the original PACTG-076, especially shorter courses of zidovudine (ZDV), combinations of antiretrovirals (ZDV and 3TC), or comparison of a modified version of the standard ZDV course vs. a single dose of nevirapine for the mother intrapartum and also for the newborn. The results of these studies may provide more affordable, alternative regimens to prevent maternal-to-child HIV-1 transmission for developing countries than the PACTG-076 protocol. It is very important that physicians and physician extenders (nurse practitioners and physician assistants) caring for infants born to HIV-infected mothers have an understanding of the pathophysiology of vertical HIV-1 infection transmission. They should be familiar with the conditions associated with an increased risk of transmission, interventions available to decrease this risk, current medications, and laboratory resources.

REFERENCES

  • 1 AIDS Epidemic Update, December. WHO/UNAIDS 1999
  • 2 Pape J W, Deschamps M M, Verdier R I. The urge for an AIDS vaccine: perspectives from a developing country.  AIDS Res Hum Retroviruses . 1992;  8 1535-1537
  • 3 Peckham C, Gibb D. Mother-to-child transmission of the human immunodeficiency virus.  N Engl J Med . 1995;  333 298-302
  • 4 Wilfert C M. Perinatal HIV transmission-a global-problem: controversy and protection of the next generation.  Semin Pediatr Infect Dis . 1998;  9 339-344
  • 5 Johann-Liang R, Cervia J S, Noel G J. Characteristics of human immunodeficiency virus-infected children at the time of death: an experience in the 1990s.  Pediatr Infect Dis J . 1997;  16 1145-1150
  • 6 The Working Group on Mother-to-Child Transmission of HIV. Rates of mother-to-child transmission of HIV-1 in Africa, America, and Europe: results from 13 perinatal studies.  J Acquir Immune Defic Syndr Hum Retroviral . 1995;  8 506-510
  • 7 The European Collaborative Study. Vertical transmission of HIV-1: maternal immune status and obstetric factors.  AIDS . 1996;  10 1675-1681
  • 8 Burns D N, Landesman S, Muenz L R. Cigarette smoking, premature rupture of membranes, and vertical transmission of HIV-1 among women with low CD4+ levels.  J Acquir Immune Defic Syndr . 1994;  7 718-726
  • 9 Hengel R L, Kennedy M S, Steketee R W. Neutralizing antibody and perinatal transmission of human immunodeficiency virus type 1.  AIDS Res Hum Retroviruses . 1998;  14 475-481
  • 10 Pelliccia P, Galli L, de Martino M. Lack of mother-to-child HIV-1 transmission is associated with elevated serum levels of 90 K immune modulatory protein.  AIDS . 2000;  14 F41-F45
  • 11 Mofenson L M, Lambert J S, Stiehm E R. Risk factors for perinatal transmission of human immunodeficiency virus type 1 in women treated with zidovudine.  N Engl J Med . 1999;  341 385-393
  • 12 Soeiro R, Rubinstein A, Rashbaum W K, Lyman W D. Materno-fetal transmission of AIDS: frequency of HIV-1 nucleic acid sequences in human fetal DNA.  J Infect Dis . 1992;  166 699-703
  • 13 De Andreis C, Simoni G, Rossella F. HIV-1 proviral DNA polymerase chain reaction detection in chorionic villi after exclusion of maternal contamination by variable number of tandem repeats analysis.  AIDS . 1996;  10 711-715
  • 14 Dunn D T, Brandt C D, Krivine A. The sensitivity of HIV-1-DNA PCR in the neonate period and the relative contributions of intrauterine and intrapartum transmission.  AIDS . 1995;  9 F7-F11
  • 15 Brossard Y, Aubin J-T, Mandelbrot L. Frequency of early in utero HIV-1 infection: a blind DNA polymerase chain reaction study on 100 fetal thymuses.  AIDS . 1995;  9 359-366
  • 16 Ehrnst A, Lindgren S, Dictor M. HIV in pregnant women and their offspring: evidence for late transmission.  Lancet . 1991;  338 203-207
  • 17 Shearer W, Quinn T C, LaRussa P. Viral load and disease progression in infants infected with human immunodeficiency virus type 1.  N Engl J Med . 1997;  336 1337-1342
  • 18 Galli L, de Martino M, Tovo P-A. Onset of clinical signs in children with HIV-1 perinatal infection.  AIDS . 1995;  9 455-461
  • 19 Bryson Y J. Perinatal HIV-1 transmission: recent advances and therapeutic interventions.  AIDS . 1996;  33-42 (33-42)
  • 20 Henin Y, Mandelbrot L, Henrion R, Pradinaud R, Coulaud J P, Montagnier L. Virus excretion in the cervicovaginal secretions of pregnant and non-pregnant women.  J Acquir Immune Defic Syndr . 1993;  6 72-75
  • 21 Goedert J J, Duliege A M, Amos C I, Felton S, Biggar R J, and The International Registry of HIV-exposed Twins. High risk of HIV-1 infection for first-born twins.  Lancet . 1991;  338 1471-1475
  • 22 Biggar R J, Miotti P G, Taha T E. Perinatal intervention trial in Africa: effect of a birth canal cleansing intervention to prevent HIV transmission.  Lancet . 1996;  347 1647-1650
  • 23 Mandelbrot L, Mayaux M J, Bongain A. Obstetric factors and mother-to-child transmission of human immunodeficiency virus type 1: the French perinatal cohort.  Am J Obstet Gynecol . 1996;  175 661-667
  • 24 Minkoff H, Burns D, Landesman S. The relationship of the duration of ruptured membranes to vertical transmission of human immunodeficiency virus.  Am J Obstet Gynecol . 1995;  173 585-589
  • 25 Nielsen K, Boyer P, Dillon M. Presence of human immunodeficiency virus (HIV) type 1 and HIV-1 specific antibodies in cervicovaginal secretions of infected mothers and in the gastric aspirates of their infants.  J Infect Dis . 1996;  173 1001-1004
  • 26 Boyer P J, Dillon M, Navaie M. Factors predictive of maternal-fetal transmission of HIV-1: preliminary analysis of zidovudine given during pregnancy and/or delivery.  JAMA . 1994;  271 1925-1930
  • 27 Landesman S H, Kalish L, Burns D N. Obstetrical factors and the transmission of HIV type 1 from mother to child-WITS.  N Engl J Med . 1996;  334 1617-1623
  • 28 Committee Opinion. Scheduled Cesarean Delivery and the Prevention of Vertical Transmission of HIV Infection. Committee on Obstetric Practice, American Academy of Obstetrics & Gynecology, Washington, DC, August 1999.
  • 29 Van de Perre P. Transmission of human immunodeficiency virus type 1 through breast-feeding: how can it be prevented?.  J Infect Dis . 1999;  S405-S407 ( S405-S407)
  • 30 Dabis F, Leroy V, Castetbon K, Spira R, Newell M-L, Salamon R. Preventing mother-to-chlid transmission of HIV-1 in Africa in the year 2000.  AIDS . 2000;  14 1017-1026
  • 31 Tess B T, Rodrigues L C, Newell M L. Sao Paolo Collaborative Study of Vertical Transmission of HIV-1. Breastfeeding among HIV-infected women in Sao Paolo State, Brazil. Conference on Global Strategies for the Prevention of HIV Transmission from Mothers to Infants. Washington, DC, September 1997 (abstract, p. 14)
  • 32 Dunn D T, Newell M L, Ades A E, Peckham C S. Risk of human immunodeficiency virus type 1 transmission through breastfeeding.  Lancet . 1992;  340 585-588
  • 33 De Martino M, Tovo P-A, Tozzi A E. HIV-1 transmission through breastmilk: appraisal of risk according to duration of feeding.  AIDS . 1992;  6 991-997
  • 34 McNeeley D F, Laroche L, Bhutra S, Suarez E, Rao S, Rajegowda B. Newborn screening for human immunodeficiency virus infection in the Bronx, NY, and evolving public health policy.  Am J Perinatol . 1999;  16 503-507
  • 35 CDC. Public Health Service Task Force recommendations for the use of antiretroviral drugs in pregnant women infected with HIV-1 for maternal health and for reducing perinatal HIV-1 transmission in the United States.  MMWR . 1998;  47(No. RR-2) 1-30
  • 36 Connor E M, Sperling R S, Gelber R, for the Pediatric AIDS Clinical Trials Group Protocol 076 Group. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment.  N Engl J Med . 1994;  331 1173-1180
  • 37 Sperling R S, Shapiro D E, Coombs R W, for the Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. Maternal viral load, zidovudine treatment, and the risk of transmission of human immunodeficiency virus type 1 from mother to infant.  N Engl J Med . 1996;  335 1621-1629
  • 38 O'Sullivan M J, Boyer P J, Scott G B. The pharmacokinetics and safety of zidovudine in the third trimester of pregnancy for women infected with HIV and their infants: phase I ACTG 082. ZDV Collaborative Working Group.  Am J Gynecol . 1992;  168 1516-1519
  • 39 Wade N A, Birkhead G S, Warren B L. Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus.  N Engl J Med . 1998;  39 1409-1414
  • 40 Culnane M, Fowler M G, Lee S S, for the Pediatric AIDS Clinical Trials Group Protocol 219/076 Teams. Lack of long-term effects of in utero exposure to zidovudine among uninfected children born to HIV-infected women.  JAMA . 1999;  281 151-157
  • 41 World Health Organization. Recommendations on the safe and effective use of short-course ZDV for prevention of mother-to-child transmission of HIV.  Wkly Epidemiol Rec . 1998;  73 313-314
  • 42 Guay L A, Musoke P, Fleming T. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial.  Lancet . 1999;  354 795-802
  • 43 Saba J. The results of the PETRA intervention trial to prevent perinatal transmission in SubSaharan Africa. In: Program and abstracts of the 6th Conference on Retroviruses and Opportunistic Infections. Chicago, January 31-February 4, 1999. Abstract 57
  • 44 Dabis F, Leroy V. Preventing mother-to-child transmission of HIV: practical strategies for developing countries.  AIDS Reader . 2000;  10 241-244
  • 45 Andiman W A. Medical management of the pregnant woman infected with human immunodeficiency virus type 1 and her child.  Semin Perinatol . 1998;  22 72-86
  • 46 Oleske J, Scott G B, and the Working Group on Antiretroviral Therapy and Medical Management of Infants, Children, and Adolescents with HIV Infection. Antiretroviral therapy and medical management of pediatric HIV infection and 1997 USPHS/IDSA report on the prevention of opportunistic infections in persons infected with human immunodeficiency virus.  Pediatrics . 1998;  1005-1085 (1005-1085)
  • 47 Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report .  1996;  8 1-39
  • 48 Rodriguez E M, Diaz C, Fowler M G. The clinical management of children perinatally exposed to HIV.  Prim Care . 1997;  24 643-666
  • 49 Nelson J D, McCracken Jr H G. AIDS and breastfeeding.  Pediatri Infect Dis J. 1998;  17. Newsletter
  • 50 Newell M L. Mechanisms and timing of maternal-to-child transmission of HIV-1.  AIDS . 1998;  12 831-836
  • 51 Bulterys M, Lepage P. Mother-to-child transmission of HIV.  Curr Opin Pediatr . 1998;  10 143-150