Perinatal Complications associated with the Human Immunodeficiency Virus. The African Experience

Abstract

Acquired immunodeficiency syndrome (AIDS) has become a global catastrophe. In sub-Saharan Africa, it is primarily a heterosexual disease. The human immunodeficiency virus (HTV-1) infects 20.8 million adults and children. Seven to forty-five percent of HIV-positive African mothers will transmit the infection to their babies, the risk increasing with the degree of immunosuppression and clinical AIDS.In Africa, the relationship between HIV-I and obstetrical complications has not been as well defined as has its relationship with neonatal and infant morbidity and mortality. The virus is believed to have accounted for the increasing maternal mortality rates in the 1990s. Rates of spontaneous abortion and stillbirth appear to be increased in the order of two to three times after adjusting for confounding variables. Effects of similar orders of magnitude are found on intra-uterine growth restriction and low birthweight infants. The relationship with premature delivery and spontaneous rupture of membranes, term or preterm, has been poorly defined.Most infants acquire their infections at or near the time of delivery. Breastfeeding presents an additional major risk with a higher transmission efficiency in primary maternal infection. African infants have an earlier onset of clinical disease and earlier mortality. Chemopro-phylaxis using zidovudine to decrease mother-to-child transmission is fraught with logistical and economic problems. Health education that is sensitive to cultural and social traditions remains the standard of prevention.