PERINATAL TRANSMISSION OF HIV AND DIAGNOSIS OF HIV-INFECTION IN INFANTS - A REVIEW

Paediatric HIV infection has become a major burden an families, commun ities and health services worldwide, The vast majority of children now acquire HIV as a result of mother to infant (vertical) transmission, Recent major advances have occurred following the greater understandin g of the risk factors for perinatal transmission and the role of antir etroviral therapy in preventing transmission, Now that interruption of vertical transmission is possible, early identification of HIV-infect ed pregnant women is critical, As of June 1997, HIV infection has beet s diagnosed in 37 children under 15 yrs of age in the Republic of Irel and; 32 as a result of maternal to infant transmission, The exact timi ng of HIV transmission during pregnancy is unclear but it is estimated that 60-70 per cent of infants may be infected at the time of deliver y with approximately 30 per cent infected earlier in gestation, Vertic al transmission rates vary from 15-40 per cent. in different global ar eas, Antenatal and perinatal zidovudine treatment can reduce this rate by 60-70 per cent, Risk factors for the vertical transmission of HIV- 1 are multifactorial. These factors include maternal disease status, i n particular maternal viral load, route of delivery, duration of membr ane rupture, presence of obstetric complications and infant feeding pr actices, Definitive diagnosis of HIV infection in infancy has been dif ficult in the past, Direct viral detection methods now allow the relia ble diagnosis of HIV infection in the first few months of life. The mo st effective intervention to reduce perinatal HIV infection will be th e better identification of HIV positive pregnant women with the subseq uent introduction of measures to interrupt vertical transmission of HI V.