Mother-to-child transmission of human immunodeficiency virus type 1

Transmission of human immunodeficiency virus (HIV) type 1 from mother to child is a significant global public health concern, with a newly infected infant born somewhere every minute. There have been many recent advances in our understanding of vertical HIV transmission. Most perinatal transmission occurs late in gestation, during delivery, or is postnatal via breast-feeding. Risk factors for perinatal HIV transmission are multifactorial and include maternal viral load, concurrent genital infections, chorioamnionitis, duration of ruptured membranes, mode of delivery, and how the infant is fed. Interventions directed at most of these factors have been evaluated for the prevention of transmission. The antiretroviral regimen of Paediatric AIDS Clinical Trials Group Study 076 is very effective and has reduced perinatal transmission in industrialised countries to less than 5%. However, the regimen is too expensive and too complicated for most developing countries of the world. Results from shorter, less complicated and less expensive trials of antiretroviral therapies to prevent transmission are just now being reported. Elective Cesarian section has also been shown to have an additive effect when used in conjunction with antiretrovirals. However, increased access to antenatal care, HIV testing, affordable antiretroviral drugs and safe alternatives to breast milk are still desperately needed in most parts of the world. (C) 1999 Lippincott Williams & Wilkins.