Abstract

Mother-to-child transmission of human immune deficiency virus (HIV) is a multifactorial event highly associated with advanced maternal HIV disease and obstetric incidents taking place during parturition. Thus, various approaches to prevention may be beneficial. Although the time and the route of materno-fetal HIV transmission are still not sufficiently clear, much speaks in favor of a late HIV transmission, most probably taking place during parturition or the phase before the delivery. The fetus is remarkably protected by the placenta and the intact fetal membranes against many viral infections during gestation. These conditions change at parturition and the chance for a transition of HIV-infected carrier cells or virus into the fetal compartment increases. Proinflammatory cytokines secreted at the materno-fetal interface accumulate in amniotic fluid and may chemoattract and stimulate potentially HIV-infected immunocytes. After rupture of membranes, maternal cells of the decidua are directly exposed to the amniotic fluid. Aside from the contamination of the fetal skin at vaginal delivery as a debatable route of infection, blood-to-blood contacts and the fetal swallowing of contaminated amniotic fluid may be the major path of fetal HIV infection. For the fetal prophylaxis of an intrauterine infection, the application of zidovudine is recommended. However, cesarian section before the onset of labor leads also to a diminution of the transmission rate. As the transmission seems to have both systemic and local causes, it makes sense to combine different intervention strategies. Whether a combination of zidovudine and elective cesarean section can lower the transmission risk further has to be evaluated.

Highlights

  • Mother-to-child transmission of human immune deficiency virus (HIV) is a multifactorial event highly associated with advanced maternal HIV disease and obstetric incidents taking place during parturition

  • Much is in favor of a late HIV transmissione,[3] most probably taking place during parturition or within two months before the delivery.[4]

  • The obstetric risks refer to the process of labor and delivery and its pathology (Table 1)

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Summary

European Collaborative Study

Risk factors for motherto-child transmission of HIV-1. Lancet 339:1007-1012, 6. Borkowsky W, Krasinski K, Cao Y, et al.: Correlation of perinatal transmission of human immunodeficiency virus type with maternal viremia and lymphocyte phenotypes. 7. Weiser B, Nachmann S, Tropper P, et al.: Quantitation of human immunodeficiency virus type during pregnancy: Relationship of viral titer to mother-to-child transmission and stability of viral load. St. Louis ME, Kamenga M, Brown C, et al.: Risk for perinatal HIV-1 transmission according to maternal immunologic, virologic and placental factors. Tovo P-A, Caesarean section and perinatal HIV transmission: What next? Lancet 342, 630, 1993

37. Schifer A
39. The European Collaborative Study
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