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Overview of Perinatal HIV Infection¹

^* Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20852 ^** Epidemiology Branch, Division of HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, GA 30333

The global HIV epidemic is having a profound impact on the health and survival of children. As of 1994, it is estimated that about 2 million children worldwide (WHO, 1994) and 12 thousand children in the United States are HIV infected (Davis et al. 1995). Almost all HIV infection among infants and young children are from mother-to-infant transmission. By the year 2000, HIV is projected to infect 40 million men, women, and children unless effective prevention strategies are developed. Perinatal HIV transmission rates currently vary from 14–40% with the lowest rates being seen in Europe and highest rates in Africa. Known risk factors for perinatal transmission include advanced maternal HIV disease, lower CD4+ counts, and increased viral burden during pregnancy. Observational cohort data suggest that prenatal vitamin A levels, maternal drug use, and duration of membrane rupture during labor also are related to risk of transmission. The United States clinical trial utilizing an antiretroviral (zidovudine [AZT]) prenatally, intrapartum, and for 6 weeks to the infant demonstrated that perinatal HIV transmission was reduced by two-thirds. This dramatic result gives strong encouragement that simpler perinatal prevention strategies applicable to developing countries may also be successful. A number of international studies are underway or planned including perinatal vitamin A and micronutrient trials in Africa.

KEY WORDS: • perinatal HIV infection • epidemiology • risk factors

¹ Presented at the workshop entitled "Nutrition in Pediatric HIV Infection: Setting the Research Agenda" held in Bethesda, MD on September 28–29, 1995. The workshop was sponsored by the Office of AIDS Research of the National Institutes of Health, the National Institute of Child Health and Human Development, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Mental Health, Food and Drug Administration, Pediatric AIDS Foundation, National Dairy Council, Sandoz Nutrition Corporation, Bristol-Meyers Squibb Company, Clintec Nutrition Company, Ross Products Division-Abbott Laboratories, Serono Laboratories, Inc., and the American Institute of Nutrition. Workshop proceedings are published as a supplement to The Journal of Nutrition. Guest Editors for this supplement publication were Daniel J. Raiten and John M. Talbot, Life Sciences Research Office, Federation of American Societies for Experimental Biology, Bethesda, MD.

² Address correspondence to: Mary Glenn Fowler, MD, MPH, Deputy Branch Chief, Efficacy Trials Branch, Division of Aids, NI-AID, NIH, Room 2A09 Solar Building, 6003 Executive Boulevard, Rockville MD 20852.