Association between the biological characteristics of HIV-1, vertical transmission of infection and clinical progression of pediatric disease

The design of effective prophylactic measures to prevent the vertical trans mission of HIV-1 and of therapies to alter the natural progression of pedia tric HIV disease requires a thorough understanding of basic pathogenetic pr inciples. Maternal viral load, the biological behavior of HIV, such as repl icative capacity in different types of cells, monocyte/macrophage tropism, and the capacity of the infant's cells to support infection have all been a ssessed for their contribution to the risk of mother-to-child transmission. Similarly, the effects of viral load and phenotype (e.g. replicative capac ity, cell tropism, syncytium-inducing capacity and the use of chemokine co- receptors) have all been investigated as parameters associated with variati ons in the expression of clinical disease in children. Some of the extant d ata are conflicting, but general principles regarding pathogenesis are begi nning to emerge. Curr Opin Infect Dis 12:239-244. (C) 1999 Lippincott Willi ams & Wilkins.