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  • Title: A prospective study of mother-to-infant HIV transmission in tribal women from India.
    Author: Kumar RM, Uduman SA, Khurranna AK.
    Journal: J Acquir Immune Defic Syndr Hum Retrovirol; 1995 Jul 01; 9(3):238-42. PubMed ID: 7788422.
    Abstract:
    The transmission of human immunodeficiency virus type 1 from infected mothers to their babies was assessed by serologic, virologic, and clinical means. Of the 160 antibody-positive women enrolled at the beginning of the study, 13 had overt clinical symptoms (CDC stage III/IV). Termination of pregnancy was done, on request, in seven of these cases. The rest delivered prematurely. A total of 143 parturient women and their infants were followed prospectively until the babies were 18 months of age. Fifteen infants (9%) died of AIDS before 14 months of age. The remaining 128 children (91%) were alive at the end of the study period. Seventy-four seropositive children (46%) became seronegative and were considered noninfected. None of the seronegative children reverted to seropositive status despite the fact that they were breast-fed. The majority of the seropositive children (63%) became symptomatic and clinically ill during infancy. The overall mother-to-infant vertical transmission rate was 48%. A prospective study was undertaken from January 1990 to June 1993 to investigate the rate and mode of perinatal transmission of HIV-1 among 160 infected pregnant tribal women in India as well as the natural history of maternally-derived HIV infection in infancy and early childhood. After screening and serological testing, seven of the 13 women who presented with clinical signs of severe AIDS choose to end their pregnancies (the other six women delivered live preterm infants), and a total of 153 children were born. None of the women received antiretroviral therapy because of economic constraints. The babies were tested for HIV-1 through serological blood tests and viral cultures within 2 days of birth and at 6-9 months and 15-18 months. Follow-up was achieved in 143 infants. Two of the preterm infants exhibited clinical signs of infection at birth. All six of the preterm infants and nine other infants died of severe AIDS by 15 months. An additional 54 infants became symptomatic during the period of observation but were alive at the conclusion of the study. 74 infants (46%) were seronegative at the end of the study. Virtually all of the infants were breast fed. In this study, the rate of vertical transmission based on the 143 infants available to follow-up was 48%. Placental membrane inflammation was detected in 42 cases, 36 of whom had HIV-1 infection; 15 of these (including the six preterm infants) died by age 15 months. It was concluded that transplacental and perinatal vertical transmission occurs most commonly shortly before and during delivery. Thus, strategies to prevent vertical transmission are urgently needed.
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