The risks and consequences of vertical transmission of HIV

• Main Author: Hague, Rosemary A.
• Published: University of Edinburgh 1992
• Subjects: 618.92
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.651932

The aims of this study were to determine the risk of transmission of HIV from mother to child, to determine factors affecting this risk, to describe the natural history of HIV infection in children, and to evaluate available therapy. Sixty eight infants of HIV seropositive women followed prospectively for a median of 44 months, were studied together with 30 controls, and 8 other children known to be HIV infected. Sixty one children became HIV antibody negative at 6-18 months. Of 11 HIV infected children, all 10 surviving beyond 18 months remained HIV antibody positive. HIV core antigen was positive in 9/11. HIV was isolated in culture of samples from 9 children; in all 10 cases tested, PCR was positive. 56 index children were followed from birth to over 18 months: 3 were HIV infected, giving a rate of 5.4% (95% Cl 0-11.3%). Early clinical indications of HIV infection included recurrent respiratory infections, recurrent diarrhoea, eczematous skin rashes, generalised lymphadenopathy, and hepatosplenomegaly. Persistent severe candidal infection heralded the development of AIDS in one infant. HIV infected children were more likely to have persistent hypergammaglobulinaemia, CD4 lymphopoenia and thrombocytopoenia. In the first 2 years, only the difference in IgG levels, noted by 6 months of life, reached significance. Of 70 infants and their mothers, 5/9 pregnancies within a year of seroconversion resulted in HIV infected children compared with 7/61 in subsequent years (p< 0.001). Increased risk of transmission was also associated with advanced maternal disease and CD4 count < 300 x 10<SUP>6</SUP>/l at delivery. Women who bore infected children were more likely to progress to CDC stage IV during follow-up (p = 0.032).