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RISK AND NATURAL HISTORY OF PERINATAL HIV TRANSMISSION.

Perinatal HIV transmission is a major public health problem. These two studies evaluated the risks, natural history, and potential interventions for it.

The first study quantified HIV RNA levels in 92 HIV- positive pregnant women who gave birth to 97 infants. Forty two women had zidovudine therapy in a variety of doses during pregnancy or during labor and delivery (or both); some were enrolled in randomized trials. Twenty of the 97 infants were perinatally infected. Seventy-five percent of transmitting mothers had HIV-1 RNA levels greater than 50,000 copies per milliliter, versus only 5 percent of nontransmitters. None of the 63 women with less than 20,000 copies per milliliter transmitted the virus. Zidovudine therapy was associated with significantly lower RNA levels and HIV transmission rates.

The second study followed 267 children with perinatal HIV infection. Sixty-three children developed complications indicating rapid progression of the disease over a 37-month follow-up, including 29 cases of encephalopathy, 45 opportunistic infections, and 3 severe bacterial infections. Risk factors for complications included liver or spleen enlargement or adenopathy, low CD4+ cell count at birth, positive antigenemia, and positive HIV PCR or culture. The diagnostic sensitivity of HIV-1 culture or polymerase chain reaction during the first week of life was 35 percent.

Comment: These studies suggest that quantitative HIV data may be used to identify women at risk for transmitting HIV to their children, and to identify newborns who may benefit from early treatment. Although the results are striking, both the authors and an accompanying editorial advise caution in defining the clinical utility of quantitative assays. All agree, however, that the risk of perinatal transmission can be reduced with zidovudine therapy for pregnant women with HIV.

— TH Lee and RH Pantell

Published in Journal Watch General Medicine March 22, 1996

Citation(s):

Dickover RE 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 Feb 28 275 599-605.

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Mayaux MJ et al. Neonatal characteristics in rapidly progressive perinatally acquired HIV-1 disease. JAMA 1996 Feb 28 275 606-610.

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Landesman SH; Burns D. Quantifying HIV. JAMA 1996 Feb 28 275 640-641.

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