POSTNATAL INCIDENCE OF HIV-I INFECTION AMONG CHILDREN IN A RURAL UGANDAN POPULATION - NO EVIDENCE FOR TRANSMISSION OTHER THAN MOTHER-TO-CHILD

We conducted a prospective cohort study to determine the post-natal in cidence of and possible transmission routes for HIV-1 infection in rur al Ugandan children. The cohort consisted of the population of a clust er of 15 villages in Masaka District, south-west Uganda, and was enrol led in 1989-1990 through a demographic and serological survey. During the period 1991-1993 the population was resurveyed annually. A total o f 5492 children aged 0-12 years were enrolled; of these, 41 (0.7%) wer e seropositive infants. A total of 1341 (72%) children were HN-negativ e on enrolment and had at least one follow-up specimen. During 8596 pe rson-years of observation only 1 seroconversion was observed, an incid ence rate of 0.12 (95% CI 0.00-0.35) per 1000 years of observation. Th e transmission of HIV was most probably through breast milk. The case corresponds to a rate of 1.1 per 1000 in households with one or more H IV-positive adults (874 years of observation); no incident case was ob served in households with only seronegative adults (6423 years of obse rvation). Thus, HIV infection among children aged 0-12 years in this p opulation is virtually exclusively the result of mother-to-child trans mission. No infections were observed attributable to parenteral exposu re, non-sexual casual or household contact, or insects.