UPDATE ON PERINATAL HIV TRANSMISSION - 06/09/11

Doi : 10.1016/S0031-3955(05)70193-0

Mary Glenn Fowler, MD, MPH ^a,^c, R.J. Simonds, MD ^b,^c,^d, Anuvat Roongpisuthipong, MD ^e

^a Mother–Child Transmission, Pediatric and Adolescent Studies Section, Epidemiology Branch (MGF)

^b International Activities Branch (RJS)

^c Division of HIV/AIDS Prevention–Surveillance and Epidemiology, Centers for Disease Control and Prevention, Atlanta, Georgia (MGF, RJS)

^d HIV/AIDS Collaboration, Bangkok, Thailand (RJS)

^e Department of Obstetrics and Gynecology, Siriraj Hospital Faculty of Medicine, Mahidol University, Bangkok, Thailand (AR)

Résumé

Worldwide, the HIV-1 epidemic has had a major impact on maternal and child health and survival. An estimated 12 million women and 1.1 million children have been infected with HIV.^{78UNAIDS/WHO Joint United Nations Programme on HIV/AIDS (UNAIDS). Report on the global HIV/AIDS epidemic. June 1998

Cliquez ici pour aller à la section Références} Moreover, approximately 500,000 infants become infected each year worldwide, and 1600 new infections occur each day. Gains in child survival attributed to widespread childhood immunization and oral rehydration programs have been severely eroded by increases in mortality from pediatric HIV infection in the 1990s.

In the United States, approximately 6000 HIV-infected women deliver each year.^{32 Stoto M.A., Almario D.A., McCormick M.C. For the Institute of Medicine. Summary: Reducing the Odds: Preventing Periatal transmission of HIV in the United States Washington, DC: National Academy Press (1998).

Cliquez ici pour aller à la section Références} Since 1994, when the results of the successful Pediatric AIDS Clinical Trial Group (PACTG) zidovudine (ZDV) perinatal trial were announced,^{16 Connor E.M., Sperling R.S., Gelber R. , et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment N Engl J Med 1994 ; 331 : 1173 [cross-ref]

Cliquez ici pour aller à la section Références} dramatic decreases have occurred in the number of new HIV infections in children born to these women, largely as a result of rapid implementation of ZDV, according to US Public Health Service (PHS) guidelines for the prevention of perinatal HIV transmission.^{17 Cooper E.R., Nugent R.P., Diaz C. , et al. After AIDS clinical trial 076: The changing pattern of zidovudine use during pregnancy, and the subsequent reduction in the vertical transmission of human immunodeficiency virus in a cohort of infected women and their infants J Infect Dis 1996 ; 174 : 1207 [cross-ref]

Cliquez ici pour aller à la section Références, 27 Fiscus S.A., Adimora A.A., Schoenback V.J. , et al. Trends in human immunodeficiency virus (HIV) counseling, testing, and antiretroviral treatment of HIV-infected women and perinatal transmission in North Carolina J Infect Dis 1999 ; 180 : 99-105 [cross-ref]

Cliquez ici pour aller à la section Références, 32 Stoto M.A., Almario D.A., McCormick M.C. For the Institute of Medicine. Summary: Reducing the Odds: Preventing Periatal transmission of HIV in the United States Washington, DC: National Academy Press (1998).

Cliquez ici pour aller à la section Références} Although these gains have been substantial, some HIV-infected pregnant women in the United States are not being offered HIV testing and not receiving ZDV to reduce their risk of transmitting HIV.

This article reviews the current knowledge about perinatal HIV-1 transmission rates and timing of transmission, discusses risk factors and pathogenesis of transmission, presents future directions for the prevention of HIV in the United States and other countries, and outlines approaches for monitoring the potential adverse effects of perinatal antiretroviral exposure.

Le texte complet de cet article est disponible en PDF.

Plan

Address reprint requests to Mary Glenn Fowler, MD, MPH, Chief, MCTPASS, Epidemiology Branch, DHAP–SE, CDC, 1600 Clifton Road, MS E–45, Atlanta, GA 30333, e-mail: [email protected]