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Nutrition and Immune Function II: Maternal Factors Influencing Transmission¹

University of Pittsburgh and Magee-Womens Research Institute, Pittsburgh, PA 15213

The risk of mother-to-child transmission of HIV ranges from 15–35 percent depending on the population under study (Fowler and Rogers 1996, Peckham and Gibb 1995). The recent finding that zidovudine treatment during pregnancy can reduce the risk of mother-to-child transmission of HIV by as much as two-thirds in some populations (CDC 1994, Connor et al. 1994), raises the question of which maternal, fetal, viral, immunologic, and placental factors play the greatest role in vertical transmission. It is clear that not only does the transmission rate vary dramatically by geographical distribution, but both the prevalence of infection and susceptibility of the uninfected may be higher in parts of the developing world. The transmission rate is significantly higher in the developing world presumably due to numerous factors including coinfection with other STD's, very little economic support for prevention, education, health maintenance or improving nutritional contributions to curb the spread of HIV. Furthermore, the strategies to reduce vertical transmission in industrialized countries are often not feasible in the developing world. Providing widescale availability of antivirals may not be feasible in areas where, to date, vitamin deficiencies often still exist. The healthcare budget in many of these developing countries cannot even pay for basic medical or prenatal services. The future directions in reducing the rate of mother-to-infant transmission must focus on strategies applicable to the developing world as well as industrialized countries. The vast majority of HIV in the pediatric age group is the result of vertical transmission of the virus. A number of maternal immunologic factors have been associated with vertical transmission. This paper offers a brief review of the extant knowledge with regard to the role of maternal factors in vertical transmission of HIV infection.

KEY WORDS: • mother-to-child transmission • zidovudine (ALT) • sexually transmitted disease (STD) • obstetrical factors • nutrition • intervention

¹ Dr. Landers was unable to attend the workshop entitled "Nutrition in Pediatric HIV Infection: Setting the Research Agenda" held in Bethesda, MD on September 28–29, 1995. The following is his prepared presentation. 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, Bistol-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. Talbolt, Life Sciences Research Office, Federation of American Societies for Experimental Biology, Bethesda, MD.