Perinatal HIV transmission and prevention
Keywords:
Perinatal HIV, Anti-retroviral therapy, Zidovudine
Abstract
Perinatal HIV transmission occurs during pregnancy, labor, delivery or breastfeeding. Maternal factors associated with increased perinatal transmission include timing of infection, immune status, mode of delivery, co-existing sexually transmitted diseases, illicit drug use, increased duration of ruptured membranes, chorioamnionitis, viral load & invasive procedures. Infant risk factors include premature birth, low birth weight, skin & mucous membrane lesions. Preventive measures include anti retroviral therapy, treatment of chorioamnionitis with antibiotics, opting for caesarean section & avoiding breastfeeding. Early appropriate treatment of subclinical chorioamnionitis & virocidal cleaning of birth canal reduces perinatal HIV transmission. Caesarean section before onset of labour & membrane rupture reduces risk of mother–infant transmission by almost 50%. Vertical HIV transmission can occur through breast-feeding mostly during first 6 weeks of life & hence avoiding breastfeeding reduces transmission. Interrupting intrapartum transmission like giving ART in late gestation/ peri-partum & elective caesarean section reduce vertical HIV acquisition. As monotherapy & dual therapy are less effective, current guidelines recommend 2 nucleoside reverse transcriptase inhibitors & either a nonnucleoside reverse transcriptase inhibitor or a protease inhibitor. Perinatal HIV transmission can be reduced through a comprehensive approach including Universal access to prenatal care & routine HIV counselling & testing, access to antiretroviral therapy during pregnancy, at delivery & postpartum, education about treatment options & regimen adherence.
Downloads
Download data is not yet available.
References
1. Erika Aaron, Elaine J. Abrams, Jean Anderson et al., Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. http://aidsinfo.nih.gov/guidelines on 6/23/2016.
2. Gonzague Lallemant, Sophie Le Coeur, Soyeon Kim, Suporn Koetsawang, Marie Anne Comeau, Wiput Phoolcharoen, Max Essex, Kenneth McIntosh, Vicharn Vithayasai: A Trial of Shortened Zidovudine Regimes to Prevent Mother-to-Child Transmission of human Immunodeficiency Virus Type 1. N Engl J Med 2000; 343:982-991October 5, 2000.DOI: 10.1056/NEJM200010053431401.
3. Bryson Y, Luzuriaga K, Sullivan JL, Wara DW: Proposed definitions for in utero versus intrapartum transmission of HIV-1. N Engl J Med. 1992 Oct 22;327(17):1246-7.
4. Boyer PJ, Dillon M, Navaie M, Deveikis A, Keller M, O'Rourke S, Bryson YJ. Factors predictive of maternal-fetal transmission of HIV-1. Preliminary analysis of zidovudine given during pregnancy and/or delivery. JAMA. 1994 Jun 22-29;271(24):1925-30. [PubMed]
5. Landesman SH1, Kalish LA, Burns DN, Minkoff H, Fox HE, Zorrilla C, Garcia P, Fowler MG, Mofenson L, Tuomala R; Obstetrical factors and the transmission of human immunodeficiency virus type 1 from mother to child. The Women and Infants Transmission Study. N Engl J Med. 1996 Jun 20;334(25):1617-23.
6. W. Andiman, M. Boucher, D. Burns et al., The International Perinatal HIV Group. The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1--a meta-analysis of 15 prospective cohort studies. N Engl J Med 1999; 340:977-987April 1, 1999DOI: 10.1056/NEJM199904013401301.
7. Read J for the International HIV Group. Duration of ruptured membranes and vertical transmission of HIV-1: a meta-analysis from fifteen prospective cohort studies. Program and abstracts of the 7th Conference on Retroviruses and Opportunistic Infections; January 30-February 2, 2000; San Francisco, Calif. Abstract 659.
8. Thea DM1, Steketee RW, Pliner V, Bornschlegel K, Brown T, Orloff S, Matheson PB, Abrams EJ, Bamji M, Lambert G, Schoenbaum EA, Thomas PA, Heagarty M, Kalish ML. The effect of maternal viral load on the risk of perinatal transmission of HIV-1. New York City Perinatal HIV Transmission Collaborative Study Group. AIDS. 1997 Mar 15;11(4):437-44. [PubMed]
9. Rodriguez EM1, Mofenson LM, Chang BH, Rich KC, Fowler MG, Smeriglio V, Landesman S, Fox HE, Diaz C, Green K, Hanson IC. Association of maternal drug use during pregnancy with maternal HIV culture positivity and perinatal transmission. AIDS. 1996 Mar;10(3):273-82.
10. Biggar RJ, Taha TE, Hoover DR, Yellin F, Kumwenda N, Broadhead R. Higher in utero and perinatal HIV infection risk in girls than boys. J Acquir Immune Defic Syndr. 2006 Apr 1;41(4):509-13. [PubMed]
11. Garcia-Bujalance S, Ruiz G, De Guevara CL, Pena JM, Bates I, Vázquez JJ, Gutiérrez A.Quantitation of human immunodeficiency virus type 1 RNA loads in cervicovaginal secretions in pregnant women and relationship between viral loads in the genital tract and blood. Eur J Clin Microbiol Infect Dis. 2004 Feb;23(2):111-5.
12. Semba, R. D. (1997). Overview of the potential role of vitamin A in mother-to-child transmission of HIV-1. Acta Paediatr Suppl. 1997 Jun; 421:107-12.
13. Burns, D. N., Landesman, S., Muenz, L. R, Nugent RP, Goedert JJ, Minkoff H, Walsh JH, Mendez H, Rubinstein A, Willoughby A. Cigarette smoking, premature rupture of membranes, and vertical transmission of HIV-1 among women with low CD4+ levels J Acquir Immune Defic Syndr. 1994 Jul;7(7):718-26.
14. Stringer , J. S. & Vermund, S. H. Prevention of mother-to-child transmission of HIV-1. Current Opinion in Obstetrics and Gynecology 1999; 11, 427-34. [PubMed]
15. Harrison, C, Chantler, E. The effect of nonoxynol-9 and chlorhexidine on HIV and sperm in vitro. Int J STD AIDS. 1998 Feb; 9(2):92-7.
16. Lee, M. J., Hallmark, R. J., Frenkel, L. M, Del Priore, G. Maternal syphilis and vertical perinatal transmission of human immunodeficiency virus type-1 infection. Int J Gynaecol Obstet. 1998 Dec;63(3):247-52.
17. American College of Obstetricians and Gynecologists. Scheduled cesarean delivery and the prevention of vertical transmission of HIV infection. ACOG Committee Opinion No. 234. Washington, DC: American College of Obstetricians and Gynecologists; 2000.
18. Bulterys M, Chao A, Munyemana S, Kurawige JB, Nawrocki P, Habimana P, Kageruka M, Mukantabana S, Mbarutso E, Dushimimana A, et al. Maternal human immunodeficiency virus 1 infection and intrauterine growth: a prospective cohort study in Butare, Rwanda. Pediatr Infect Dis J.1994;13:94–100. doi:10.1097/00006454-199402000-00003.
19. Ruff M, Henne C, Barth T, Rinaldi N, Sträter J, Schwartz-Albiez R, Möller P. PMA-activation of peripheral blood and tonsillar B lymphocytes induces large adhesive cells reminiscent of large extrafollicular (monocytoid) B cells; Virchows Arch. 1994;424(2):195-204.
20. Palasanthiran P . Breastfeeding during primary maternal immunodeficiency virus infection and risk of transmission from mother to infant. Journal of Infectious Diseases, 1993, 167:441–444.
21. Dunn, D. T., Newell, M. L., Ades, A. E, Peckham, C. S. Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet. 1992 Sep 5;340(8819):585-8.
22. Leroy, V., Newell, M. L., Dabis, F., Peckham, C., Van de Perre, P., Bulterys, M, Kind C, Simonds RJ, Wiktor S, Msellati P. International multicentre pooled analysis of late postnatal mother-to-child transmission of HIV-1 infection. Ghent International Working Group on Mother-to-Child Transmission of HIV. Lancet. 1998 Aug 22;352(9128):597-600.
23. Semba, R. D., Kumwenda, N., Hoover, D. R., Taha, T. E., Quinn, T. C., Mtimavalye, L. et al. (1999). Human immunodeficiency virus load in breast milk, mastitis, and mother-to-child transmission of human immunodeficiency virus type 1. J Infect Dis. (1999) 180 (1): 93-98. doi: 10.1086/314854
24. Wade, N. A., Birkhead, G. S., Warren, B. L., Charbonneau, T. T., French, P. T, Wang L, Baum JB, Tesoriero JM, Savicki R. Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. N Engl J Med. 1998 Nov 12;339(20):1409-14.
25. Annemiek de Ruiter, Graham P Taylor, Ms Polly Clayden et al., Guidelines for the management of HIV infection in pregnant women (2014 interim review); British HIV Association. HIV Medicine (2014), 15 (Suppl. 4), 1–77. DOI: 10.1111/hiv.12185.
26. Sperling RS, Shapiro DE, Coombs RW, Todd JA, Herman SA, McSherry GD, O'Sullivan MJ, Van Dyke RB, Jimenez E, Rouzioux C, Flynn PM, Sullivan JL. Maternal viral load, zidovudine treatment, and the risk of transmission of human immunodeficiency virus type 1 from mother to infant. N Engl J Med. 1996 Nov 28;335(22):1621-9.
27. Hudson CP. Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of HIV-1 from mother to child in Tanzania, South Africa, and Uganda (Petra study): a randomised, double-blind, placebo-controlled trial. Lancet. 2002 Apr 6;359(9313):1178-86.
28. Guay, L. A, Musoke, P, Fleming T, Bagenda D, Allen M, Nakabiito C, Sherman J, Bakaki P, Ducar C, Deseyve M, Emel L, Mirochnick M, Fowler MG, Mofenson L, Miotti P, Dransfield K, Bray D, Mmiro F, Jackson JB. Intra-partum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet. 1999 Sep 4;354(9181):795-802.
2. Gonzague Lallemant, Sophie Le Coeur, Soyeon Kim, Suporn Koetsawang, Marie Anne Comeau, Wiput Phoolcharoen, Max Essex, Kenneth McIntosh, Vicharn Vithayasai: A Trial of Shortened Zidovudine Regimes to Prevent Mother-to-Child Transmission of human Immunodeficiency Virus Type 1. N Engl J Med 2000; 343:982-991October 5, 2000.DOI: 10.1056/NEJM200010053431401.
3. Bryson Y, Luzuriaga K, Sullivan JL, Wara DW: Proposed definitions for in utero versus intrapartum transmission of HIV-1. N Engl J Med. 1992 Oct 22;327(17):1246-7.
4. Boyer PJ, Dillon M, Navaie M, Deveikis A, Keller M, O'Rourke S, Bryson YJ. Factors predictive of maternal-fetal transmission of HIV-1. Preliminary analysis of zidovudine given during pregnancy and/or delivery. JAMA. 1994 Jun 22-29;271(24):1925-30. [PubMed]
5. Landesman SH1, Kalish LA, Burns DN, Minkoff H, Fox HE, Zorrilla C, Garcia P, Fowler MG, Mofenson L, Tuomala R; Obstetrical factors and the transmission of human immunodeficiency virus type 1 from mother to child. The Women and Infants Transmission Study. N Engl J Med. 1996 Jun 20;334(25):1617-23.
6. W. Andiman, M. Boucher, D. Burns et al., The International Perinatal HIV Group. The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1--a meta-analysis of 15 prospective cohort studies. N Engl J Med 1999; 340:977-987April 1, 1999DOI: 10.1056/NEJM199904013401301.
7. Read J for the International HIV Group. Duration of ruptured membranes and vertical transmission of HIV-1: a meta-analysis from fifteen prospective cohort studies. Program and abstracts of the 7th Conference on Retroviruses and Opportunistic Infections; January 30-February 2, 2000; San Francisco, Calif. Abstract 659.
8. Thea DM1, Steketee RW, Pliner V, Bornschlegel K, Brown T, Orloff S, Matheson PB, Abrams EJ, Bamji M, Lambert G, Schoenbaum EA, Thomas PA, Heagarty M, Kalish ML. The effect of maternal viral load on the risk of perinatal transmission of HIV-1. New York City Perinatal HIV Transmission Collaborative Study Group. AIDS. 1997 Mar 15;11(4):437-44. [PubMed]
9. Rodriguez EM1, Mofenson LM, Chang BH, Rich KC, Fowler MG, Smeriglio V, Landesman S, Fox HE, Diaz C, Green K, Hanson IC. Association of maternal drug use during pregnancy with maternal HIV culture positivity and perinatal transmission. AIDS. 1996 Mar;10(3):273-82.
10. Biggar RJ, Taha TE, Hoover DR, Yellin F, Kumwenda N, Broadhead R. Higher in utero and perinatal HIV infection risk in girls than boys. J Acquir Immune Defic Syndr. 2006 Apr 1;41(4):509-13. [PubMed]
11. Garcia-Bujalance S, Ruiz G, De Guevara CL, Pena JM, Bates I, Vázquez JJ, Gutiérrez A.Quantitation of human immunodeficiency virus type 1 RNA loads in cervicovaginal secretions in pregnant women and relationship between viral loads in the genital tract and blood. Eur J Clin Microbiol Infect Dis. 2004 Feb;23(2):111-5.
12. Semba, R. D. (1997). Overview of the potential role of vitamin A in mother-to-child transmission of HIV-1. Acta Paediatr Suppl. 1997 Jun; 421:107-12.
13. Burns, D. N., Landesman, S., Muenz, L. R, Nugent RP, Goedert JJ, Minkoff H, Walsh JH, Mendez H, Rubinstein A, Willoughby A. Cigarette smoking, premature rupture of membranes, and vertical transmission of HIV-1 among women with low CD4+ levels J Acquir Immune Defic Syndr. 1994 Jul;7(7):718-26.
14. Stringer , J. S. & Vermund, S. H. Prevention of mother-to-child transmission of HIV-1. Current Opinion in Obstetrics and Gynecology 1999; 11, 427-34. [PubMed]
15. Harrison, C, Chantler, E. The effect of nonoxynol-9 and chlorhexidine on HIV and sperm in vitro. Int J STD AIDS. 1998 Feb; 9(2):92-7.
16. Lee, M. J., Hallmark, R. J., Frenkel, L. M, Del Priore, G. Maternal syphilis and vertical perinatal transmission of human immunodeficiency virus type-1 infection. Int J Gynaecol Obstet. 1998 Dec;63(3):247-52.
17. American College of Obstetricians and Gynecologists. Scheduled cesarean delivery and the prevention of vertical transmission of HIV infection. ACOG Committee Opinion No. 234. Washington, DC: American College of Obstetricians and Gynecologists; 2000.
18. Bulterys M, Chao A, Munyemana S, Kurawige JB, Nawrocki P, Habimana P, Kageruka M, Mukantabana S, Mbarutso E, Dushimimana A, et al. Maternal human immunodeficiency virus 1 infection and intrauterine growth: a prospective cohort study in Butare, Rwanda. Pediatr Infect Dis J.1994;13:94–100. doi:10.1097/00006454-199402000-00003.
19. Ruff M, Henne C, Barth T, Rinaldi N, Sträter J, Schwartz-Albiez R, Möller P. PMA-activation of peripheral blood and tonsillar B lymphocytes induces large adhesive cells reminiscent of large extrafollicular (monocytoid) B cells; Virchows Arch. 1994;424(2):195-204.
20. Palasanthiran P . Breastfeeding during primary maternal immunodeficiency virus infection and risk of transmission from mother to infant. Journal of Infectious Diseases, 1993, 167:441–444.
21. Dunn, D. T., Newell, M. L., Ades, A. E, Peckham, C. S. Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet. 1992 Sep 5;340(8819):585-8.
22. Leroy, V., Newell, M. L., Dabis, F., Peckham, C., Van de Perre, P., Bulterys, M, Kind C, Simonds RJ, Wiktor S, Msellati P. International multicentre pooled analysis of late postnatal mother-to-child transmission of HIV-1 infection. Ghent International Working Group on Mother-to-Child Transmission of HIV. Lancet. 1998 Aug 22;352(9128):597-600.
23. Semba, R. D., Kumwenda, N., Hoover, D. R., Taha, T. E., Quinn, T. C., Mtimavalye, L. et al. (1999). Human immunodeficiency virus load in breast milk, mastitis, and mother-to-child transmission of human immunodeficiency virus type 1. J Infect Dis. (1999) 180 (1): 93-98. doi: 10.1086/314854
24. Wade, N. A., Birkhead, G. S., Warren, B. L., Charbonneau, T. T., French, P. T, Wang L, Baum JB, Tesoriero JM, Savicki R. Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. N Engl J Med. 1998 Nov 12;339(20):1409-14.
25. Annemiek de Ruiter, Graham P Taylor, Ms Polly Clayden et al., Guidelines for the management of HIV infection in pregnant women (2014 interim review); British HIV Association. HIV Medicine (2014), 15 (Suppl. 4), 1–77. DOI: 10.1111/hiv.12185.
26. Sperling RS, Shapiro DE, Coombs RW, Todd JA, Herman SA, McSherry GD, O'Sullivan MJ, Van Dyke RB, Jimenez E, Rouzioux C, Flynn PM, Sullivan JL. Maternal viral load, zidovudine treatment, and the risk of transmission of human immunodeficiency virus type 1 from mother to infant. N Engl J Med. 1996 Nov 28;335(22):1621-9.
27. Hudson CP. Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of HIV-1 from mother to child in Tanzania, South Africa, and Uganda (Petra study): a randomised, double-blind, placebo-controlled trial. Lancet. 2002 Apr 6;359(9313):1178-86.
28. Guay, L. A, Musoke, P, Fleming T, Bagenda D, Allen M, Nakabiito C, Sherman J, Bakaki P, Ducar C, Deseyve M, Emel L, Mirochnick M, Fowler MG, Mofenson L, Miotti P, Dransfield K, Bray D, Mmiro F, Jackson JB. Intra-partum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet. 1999 Sep 4;354(9181):795-802.
CITATION
DOI: 10.17511/joog.2016.i02.04
Published: 2016-06-30
How to Cite
Chandran, R. (2016). Perinatal HIV transmission and prevention. Obs Gyne Review: Journal of Obstetric and Gynecology, 2(2), 12-16. https://doi.org/10.17511/joog.2016.i02.04
Section
Review Article
Copyright (c) 2016 Author (s). Published by Siddharth Health Research and Social Welfare Society
This work is licensed under a Creative Commons Attribution 4.0 International License.
OAI - Open Archives Initiative
Therapoid
