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  • Title: Update on vertical HIV transmission.
    Author: Groginsky E, Bowdler N, Yankowitz J.
    Journal: J Reprod Med; 1998 Aug; 43(8):637-46. PubMed ID: 9749412.
    Abstract:
    OBJECTIVE: To describe the factors that contribute to vertical transmission of human immunodeficiency virus (HIV) and review means of decreasing the risk of transmission. STUDY DESIGN: Medline search of the international English-language literature pertaining to HIV in pregnancy from 1989 to the present. Special emphasis was placed on articles published in the last three years related to vertical transmission as well as to antepartum, intrapartum and postpartum management to reduce transmission. RESULTS: High levels of maternal viral load and more advanced maternal disease are associated with a greater risk of vertical transmission of HIV. Antepartum and intrapartum maternal treatment with zidovudine and postpartum neonatal zidovudine treatment decreases the risk of transmission by two-thirds, at least in patients with earlier stages of the disease. Breast-feeding is a source of postpartum HIV transmission and may double the total transmission rate. CONCLUSION: Zidovudine should be used in pregnancy to decrease the viral load and reduce transmission of HIV to the fetus. Other antiviral agents should be used during pregnancy if indicated, although current information is lacking about their effects on the fetus and any potential benefits in decreasing vertical transmission of HIV. Breast-feeding should be avoided. A search of MEDLINE for English-language literature published from 1989 to the present was conducted to identify the factors that affect vertical transmission of HIV infection as well as ways to reduce risk. As of August 1998, there were an estimated million people infected with HIV in the US, and, in 1994, AIDS was the third-leading cause of death among women aged 25-44 years. The prevalence of maternal-fetal transmission is approximately 1.6/1000 births. Neonatal transmission rates in the US are 15-25% as compared to 25-35% in Africa. It is believed that 50% of vertical transmission occurs during labor and delivery through exposure to secretions and blood. HIV is also transmitted through breast milk. The literature review revealed several postulated determinants of vertical transmission, such as maternal, obstetric, infant, and viral factors. The literature indicates that high levels of maternal viral load and advanced maternal disease increase risk of vertical transmission, that treatment of pregnant women and newborns with zidovudine decreases transmission risk, and that breast feeding should be avoided unless there is no safe alternative to breast milk. In addition, it is recommended that HIV-positive pregnant women undergo assessment of viral load and degree of immunosuppression, that infected women be treated with oral zidovudine during pregnancy and intravenous zidovudine during labor, that combination therapy be considered when appropriate, and that patients be counseled about the risk of transmission during invasive prenatal testing.
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