Irish Journal of Medical Science

, Volume 167, Issue 1, pp 28–32 | Cite as

Perinatal transmission of hiv and diagnosis of hiv infection in infants: A review

  • C. B. Nourse
  • K. M. Butler


Paediatric HIV infection has become a major burden on families, communities and health services worldwide. The vast majority of children now acquire HIV as a result of mother to infant (vertical) transmission. Recent major advances have occurred following the greater understanding of the risk factors for perinatal transmission and the role of antiretroviral therapy in preventing transmission. Now that interruption of vertical transmission is possible, early identification of HIV-infected pregnant women is critical. As of June 1997, HIV infection has been diagnosed in 37 children under 15 yrs of age in the Republic of Ireland; 32 as a result of maternal to infant transmission. The exact timing of HIV transmission during pregnancy is unclear but it is estimated that 60–70 per cent of infants may be infected at the time of delivery with approximately 30 per cent infected earlier in gestation. Vertical transmission rates vary from 15–40 per cent in different global areas. Antenatal and perinatal zidovudine treatment can reduce this rate by 60–70 per cent. Risk factors for the vertical transmission of HIV-1 are multifactorial. These factors include maternal disease status, in particular maternal viral load, route of delivery, duration of membrane rupture, presence of obstetric complications and infant feeding practices. Definitive diagnosis of HIV infection in infancy has been difficult in the past. Direct viral detection methods now allow the reliable diagnosis of HIV infection in the first few months of life.


Human Immunodeficiency Virus Human Immunodeficiency Virus Infection Zidovudine Vertical Transmission Perinatal Transmission 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    World Health Organisation, AIDS-global data. Wkly. Epidemiol. Rec. 1995; 70: 353–355.Google Scholar
  2. 2.
    Chin, J., Mann, J. M. Global surveillance and forecasting of AIDS. Bull. World Health Organ. 1997; 336: 1–7.Google Scholar
  3. 3.
    Buehler, J. W., Berkelman, R. L., Curran, J. W. Reporting of AIDS: tracking HIV morbidity and mortality. JAMA 1989; 262: 2896–2897.PubMedCrossRefGoogle Scholar
  4. 4.
    Chrystie, I. L., Palmer, S. J., Kenny, A., Banatvala, J. E. HIV Seroprevalence among women attending antenatal clinics in London. Lancet 1992; 339: 364.PubMedCrossRefGoogle Scholar
  5. 5.
    McLaws, M., Brown, A., Cunningham, P., Imrie, A., Wilcken, B., Cooper, D. Prevalence of maternal HIV infection based on anonymous testing of neonates, Sydney 1989. Med. J. Aust. 1990; 153.Google Scholar
  6. 6.
    Ades, A., Parker, S., Berry, T., Holland, F. Prevalence of maternal HIV-1 infection in Thames Regions: results from anonymous unlinked neonatal testing. Lancet 1991; 337: 1562–1565.PubMedCrossRefGoogle Scholar
  7. 7.
    Schechter, M. T., Ballem, P. J., Buskard, N. A. An anonymous seroprevalence survey of HIV infection among pregnant women in British Columbia and the Yukon teritory. Can. Med. Assos. J. 1990; 143: 1187–1192.Google Scholar
  8. 8.
    Ippolito, G., Stegagno, M., Girardi, E., Costa, F., Rava, L., Aebischer, M. L. Temporal and geographical trends of anti-HIV-1 antibodies screening among newborns in Italy, 1990–1993. Italian Collaborative Study Group for HIV Prevalence in Newborns. Journal of Acquired Immune Deficiency Syndromes 1996; 12: 63–68.Google Scholar
  9. 9.
    Leroy, V., Van de Perre, P., Lepage, P. et al. Seroincidence of HIV-1 infection in African women of reproductive age: a prospective cohort study in Kigali, Rwanda, 1988–1992. AIDS 1994; 8: 983–986.PubMedCrossRefGoogle Scholar
  10. 10.
    Batter, V., Matela, B., Nsuami, M., et al. High HIV-1 incidence in young women masked by stable overall seroprevalence among childbearing women in Kinshasa, Zaire: estimating incidence from serial seroprevalence data. AIDS 1994; 8: 811–817.PubMedCrossRefGoogle Scholar
  11. 11.
    Anonymous. Nationwide community-based serological survey of HIV-1 and other human retrovirus infections in a central African country. Rwandan HIV Seroprevalence Study Group. Lancet 1989; 1: 941–943.Google Scholar
  12. 12.
    Allen, S., Lindan, C., Serufilira, A. et al. Human immunodeficiency virus infection in urban Rwanda Demographic and behavioral correlates in a representative sample of childbearing women. JAMA 1991; 266: 1657–1663.PubMedCrossRefGoogle Scholar
  13. 13.
    Ryder, R., Nsa, W., Hassig, S., Behets, F. Perinatal transmission of the Human Immunodeficiency virus Type 1 to infants of seropositive women in Zaire. N. Engl. J. Med. 1989; 320: 1637–1642.PubMedGoogle Scholar
  14. 14.
    Braddick, M. R., Kreiss, J. K., Embree, J. E. Impact of maternal HIV infection on obstetrical and neonatal outcome. AIDS 1990; 1001-1005.Google Scholar
  15. 15.
    Temmerman, M., Chomba, E. N., Ndinya-Achola, J., Plummer, F. A., Coppens, M., Piot, P. Maternal human immunodeficiency virus-1 infection and pregnancy outcome. Obstet. Gynecol. 1994; 83: 495–501.PubMedCrossRefGoogle Scholar
  16. 16.
    Minkoff, H., Henderson, C., Mendez, H. Pregnancy outcomes among mothers infected with human immunodeficiency virus and uninfected control subjects. Am. J. Obstet. Gynecol. 1990; 163: 1598–1604.PubMedGoogle Scholar
  17. 17.
    Johnstone, F., MacCullum, L. Does infection with HIV affect the outcome of pregnancy? BMJ 1988; 296.Google Scholar
  18. 18.
    Langston, C., Lewis, D. E., Hammill, H. A. et al. Excess intrauterine fetal demise associated with maternal human immunodeficiency virus infection. J. Infect. Dis. 1995; 172: 1451–1460.PubMedGoogle Scholar
  19. 19.
    European Collaborative Study. Mother to child transmission of HIV infection. Lancet 1988; 2: 1039–1043.CrossRefGoogle Scholar
  20. 20.
    European Collaborative Study. Risk factors for mother to child transmission of HIV-1. Lancet 1992; 339:1007–1012.CrossRefGoogle Scholar
  21. 21.
    Halsey, N. A., Boulos, R., Holt, E., et al. Transmission of HIV-1 infections from mothers to infants in Haiti. Impact on childhood mortality and malnutrition. The CDS/JHU AIDS Project Team. JAMA 1990; 264: 2088–2092.PubMedCrossRefGoogle Scholar
  22. 22.
    Hira, S. K., Kamanga, J., Bhat, G. J. et al. Perinatal transmission of HIV-1 in Zambia. BMJ 1989; 299: 1250–1252.PubMedGoogle Scholar
  23. 23.
    Blanche, S., Rouzioux, C., Moscato, M. L. et al. A prospective study of infants born to women seropositive for human immunodeficiency virus type 1. HIV Infection in Newborns French Collaborative Study Group. N. Engl. J. Med. 1989; 320: 1643–1648.PubMedGoogle Scholar
  24. 24.
    Nesheim, S. R., Lindsay, M., Sawyer, M. K., et al. A prospective population-based study of HIV perinatal transmission. AIDS 1994; 8: 1293–1298.PubMedGoogle Scholar
  25. 25.
    Peckham, C., Gibb, D. Mother-to-child transmission of the human immunodeficiency virus. N. Engl. J. Med. 1995; 333: 298–302.PubMedCrossRefGoogle Scholar
  26. 26.
    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. 1995; 8: 1495–1497.Google Scholar
  27. 27.
    Ehrnst, A., Lindgren, S., Dictor, M. et al. HIV in pregnant women and their offspring: evidence for late transmission. Lancet 1991; 338: 203–207.PubMedCrossRefGoogle Scholar
  28. 28.
    Bryson, Y. J., Luzuriaga, K., Sullivan, J. L., Wara, D. W. Proposed definitions for in utero versus intrapartum transmission of HIV-1. N. Engl. J. Med. 1992; 327: 1246–1247.PubMedGoogle Scholar
  29. 29.
    Rouzioux, C., Costagliola, D., Burgard, M. et al. Estimated timing of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission by use of a Markov model. The HIV Infection in Newborns French Collaborative Study Group. American Journal of Epidemiology 1995; 142: 1330–1337.PubMedGoogle Scholar
  30. 30.
    Kalish, L. A., Pitt, J., Lew, J. et al. Defining the time of fetal or perinatal acquisition of human immunodeficiency virus type 1 infection on the basis of age at first positive culture. J. Infect. Dis. 1997; 175: 712–715.PubMedGoogle Scholar
  31. 31.
    Shearer, W. T., Quinn, T. C., Larussa, P. et al. Viral load and disease progression in infants infected with human immunodeficiency virus type 1. N. Engl. J. Med. 1997; 336: 1337–1342.PubMedCrossRefGoogle Scholar
  32. 32.
    The European Collaborative Study, Vertical transmission of HIV-1: maternal immune status and obstetric factors. AIDS 1996; 10: 1675–1681.Google Scholar
  33. 33.
    Mandelbrot, L., Mayaux, M., Bongain, A. et al. Obstetric factors and mother-to-child transmission of human immunodeficiency virus type 1: The French perinatal cohorts. N. Engl. J. Med. 1994; 331: 1173–1180.CrossRefGoogle Scholar
  34. 34.
    Thomas, P. A., Weedon, J., Krasinski, K. et al. Maternal predictors of perinatal human immunodeficiency virus transmission. The New York City Perinatal HIV Transmission Collaborative Study Group. Pediatr. Infect. Dis. J. 1994; 13: 489–495.PubMedGoogle Scholar
  35. 35.
    Tibaldi, C., Tovo, P. A., Ziarati, N. et al. Asymptomatic women at high risk of vertical HIV-1 transmission to their fetuses. Br. J. Obs. Gynae. 1993; 100: 334–337.Google Scholar
  36. 36.
    Pitt, J., Brambilla, D., Reichelderfer, P. et al. Maternal immunologic and virologic risk factors for infant human immunodeficiency virus type 1 infection - Findings from the women and infants transmission study. J. Infect. Dis. 1997; 175: 567–575.PubMedGoogle Scholar
  37. 37.
    Boyer, P. J., Dillon, M., Navaie, M., Deveikis, A., Keller, M., O’Rourke, S. Factors predictive of maternal-fetal transmission of HIV-1. Preliminary analysis of zidovudine given during pregnancy and/or delivery. JAMA 1994; 271: 1925–1930.PubMedCrossRefGoogle Scholar
  38. 38.
    Roques, P., Marce, D., Courpotin, C. et al. Correlation between HIV provirus burden and in utero transmission. AIDS 1993; 7 Suppl 2: S39-S43.PubMedCrossRefGoogle Scholar
  39. 39.
    St Louis, M. E., Kamenga, M., Brown, C. et al. Risk for perinatal HIV-1 transmission according to maternal immunologic, virologic, and placental factors. JAMA 1993; 269: 2853–2859.CrossRefGoogle Scholar
  40. 40.
    Dickover, R. E., Garratty, E. M., Herman, S. A. et al. Identification of levels of maternal HIV-1 RNA associated with risk of perinatal transmission. Effect of maternal zidovudine treatment on viral load. JAMA 1996; 275: 599–605.PubMedCrossRefGoogle Scholar
  41. 41.
    Borkowsky, W., Krasinski, K., Cao, Y. et al. Correlation of perinatal transmission of human immunodeficiency virus type 1 with maternal viremia and lymphocyte phenotypes. J. Paeds. 1994; 125:345–351.CrossRefGoogle Scholar
  42. 42.
    Fang, G., Burger, H., Grimson, R. et al. Maternal plasma human immunodefiency virus type 1 RNA level: A determinant and projected threshold for mother-to-child transmission. Proc. Natl. Acad. Sci. 1995; 92: 12100–12104.PubMedCrossRefGoogle Scholar
  43. 43.
    Zollner, B., Heinz-Hubert, F., Helling-Geise, G., Schroter, M., Laufs, R. HIV quantification: useful for prediction of vertical transmission? Lancet 1996; 347:899.PubMedCrossRefGoogle Scholar
  44. 44.
    Coll, O., Hernandez, M., Boucher, C. A. B. et al. Vertical HIV- 1 transmission correlates with a high maternal viral load at delivery. J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. 1997; 14: 26–30.PubMedGoogle Scholar
  45. 45.
    Mayaux, M. J., Dussaix, E., Isopet, J. et al. Maternal virus load during pregnancy and mother-to-child transmission of human immunodeficiency virus type 1: The French perinatal cohort studies. J. Infect. Dis. 1997; 175: 172–175.PubMedGoogle Scholar
  46. 46.
    Kliks, S. C., Wara, D. W., Landers, D. V., Levy, J. A., Features of HIV-1 that could influence maternal-child transmission. JAMA 1994; 272: 467–474.PubMedCrossRefGoogle Scholar
  47. 47.
    Goedert, J. J., Duliege, A. M., Amos, C. I., Felton, S., Biggar, R. J. High risk of HIV-1 infection for first-born twins. The International Registry of HIV-exposed Twins. Lancet 1991; 338: 1471–1475.PubMedGoogle Scholar
  48. 48.
    Villari, P., Spino, C., Chalmers, T. C., Lau, J., Sacks, H. S., Cesarean section to reduce perinatal transmission of human immunodeficiency virus. A metaanalysis. Online J. Curr. Clin. Trials 1993; Doc. No 74.Google Scholar
  49. 49.
    Anonymous, Caesarean section and risk of vertical transmission of HIV-1 infection. The European Collaborative Study. Lancet 1994;343:1464-1467.Google Scholar
  50. 50.
    Thiry, L., Sprecher-Goldberger, S., Jonckheer, T. et al. Isolation of AIDS virus from cell-free breast milk of three healthy virus carriers. Lancet 1985; 2: 891–892.PubMedCrossRefGoogle Scholar
  51. 51.
    Van de Perre, P., Simonon, A., Hitimana, D. G. et al. Infective and anti-infective properties of breastmilk from HIV-1-infected women. Lancet 1993; 341: 914–918.PubMedCrossRefGoogle Scholar
  52. 52.
    Buranasin, P., Kunakorn, M., Petchclai, B., Raksakait, K., Wichukchinda, N., Thongcharoen, P. Detection of human immunodeficiency virus type 1 (HIV-1) proviral DNA in breast milk and colostrum of seropositive mothers. J. Med. Assoc. Thai. 1993; 76: 41–45.PubMedGoogle Scholar
  53. 53.
    Villari, P., Cooper, D. A., Johnson, R. O., Gold, J. Postnatal transmission of AIDS-associated retrovirus from mother to infant. Lancet 1985; 1: 896–898.Google Scholar
  54. 54.
    Anonymous. Global programme on AIDS. Consensus statement from the WHO/UNICEF consultation on HIV transmission and breast-feeding. Wkly. Epidemiol. Rec. 1992; 67: 177–179.Google Scholar
  55. 55.
    Connor, E. M., Sperling, R. S., Gelber, R. et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N. Engl. J. Med. 1994; 331: 1173–1180.PubMedCrossRefGoogle Scholar
  56. 56.
    Frenkel, L. M., Cowles, M. K., Shapiro, D. E. et al. Analysis of the maternal components of the AIDS Clinical Trial Group 076 zidovudine regimen in the prevention of mother-to-infant transmission of human immunodeficiency virus type 1. J. Infect. Dis. 1997; 175: 971–974.PubMedCrossRefGoogle Scholar
  57. 57.
    Lambert, J. S., Mofenson, L. M., Fletcher, C. V. et al. Safety and pharmacokinetics of hyperimmune anti-human immunodeficiency virus (HIV) immunoglobulin administered to HIV-infected pregnant women and their newborns. J. Infect. Dis. 1997; 175: 283–291.PubMedGoogle Scholar
  58. 58.
    Fransen, K., Pollet, D. E., Peeters, M. et al. Evaluation of a line immunoassay for simultaneous confirmation of antibodies to HIV-1 and HIV-2. Eur. J. Clin. Microbiol. Infect. Dis. 1991; 10: 939–946.PubMedCrossRefGoogle Scholar
  59. 59.
    Church, J. A. The diagnostic challenge of the child born “at risk” for HIV infection. Pediatr. Clin. North Am. 1994; 41: 715–726.PubMedGoogle Scholar
  60. 60.
    Palumbo, P. Laboratory findings in HIV infection in infancy. Clin. Perinatal. 1994; 21: 109–124.Google Scholar
  61. 61.
    Nesheim, S., Lee, F., Kalish, M. L. et al. Diagnosis of perinatal human immunodeficiency virus infection by polymerase chain reaction and P24 detection after immune complex dissociation in an urban community hospital. J. Infect. Dis. 1997; 175: 1333–1336.PubMedCrossRefGoogle Scholar
  62. 62.
    Kline, M. W., Lewis, D. E., Hollinger, F. B. et al. Acomparative study of human immunodeficiency virus culture, polymerase chain reaction and anti-human immunodeficiency virus immunoglobulin A antibody detection in the diagnosis during early infancy of vertically acquired human immunodeficiency virus infection. Pediatr. Infect. Dis. J. 1994; 13: 90–94.PubMedCrossRefGoogle Scholar
  63. 63.
    Rogers, M. F., Ou, C. Y., Rayfield, M. et al. Use of the polymerase chain reaction for early detection of the proviral sequences of human immunodeficiency virus in infants born to seropositive mothers. New York City Collaborative Study of Maternal HIV Transmission and Montefiore Medical Center HIV Perinatal Transmission Study Group. N. Engl. J. Med. 1989; 320: 1649–1654.PubMedGoogle Scholar
  64. 64.
    Comeau, A. M., Harris, J. A., Mclntosh, K., Weiblen, B. J., Hoff, R., Grady, G. F. Polymerase chain reaction in detecting HIV infection among seropositive infants: relation to dinical status and age and to results of other assays. Journal of Acquired Immune Deficiency Syndromes 1992; 5: 271–278.PubMedGoogle Scholar
  65. 65.
    Burgard, M., Mayaux, M. J., Blanche, S. et al. The use of viral culture and p24 antigen testing to diagnose human immunodeficiency virus infection in neonates. The HIV Infection in Newborns French Collaborative Study Group. N. Engl. J. Med. 1992; 327: 1192–1197.PubMedGoogle Scholar
  66. 66.
    Steketee, R. W., Abrams, E. J., Thea, D. M., et al. Early detection of perinatal human immunodeficiency virus (HIV) type 1 infection using HIV RNA amplification and detection. J. Infect. Dis. 1997; 175: 707–711.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1998

Authors and Affiliations

  • C. B. Nourse
    • 1
    • 2
  • K. M. Butler
    • 1
  1. 1.Department of PaediatricsUniversity College Dublin and Our Lady’s Hospital for Sick ChildrenCrumlin
  2. 2.Children’s Research CentreOur Lady’s Hospital for Sick ChildrenCrumlin

Personalised recommendations