Reduction of Maternal–Infant Transmission of HIV Type 1 With Zidovudine Treatment

This article summarizes the landmark results of Pediatric AIDS Clinical Trials Group Protocol 076. Pregnant women between 14 and 34 weeks with a CD4 count above 200 and no indication for antiretroviral therapy were randomized to zidovudine treatment or placebo. Zidovudine was shown to reduce HIV transmission from mother to child by 67.5%. Zidovudine treatment was not associated with neonatal death, premature birth, fetal growth or structural abnormalities. The majority of maternal adverse effects were obstetric complications that were not associated with either placebo or intervention groups. It reviews study design, findings, and limitations. This study is then situated in historical context and in reference to current guidelines.

Antiretroviral Therapy in Pregnant Women

Upon completion of this chapter, the reader should be able to describe the appropriate management of antiretrovirals for pregnant women living with HIV. Over time, research has demonstrated that proper prevention strategies and interventions during pregnancy, labor, and delivery can significantly reduce the rate of mother-to-child transmission (MTCT) of HIV. In 1994, a pivotal study in the field of HIV medicine, the Pediatric AIDS Clinical Trials Group 076, demonstrated that the use of zidovudine (ZDV) monotherapy during pregnancy substantially reduced the risk of HIV transmission to infants by 67% (...

Pediatric HIV-1 Acquisition and Lifelong Consequences of Infant Infection

Increased availability of antiretroviral therapy to pregnant and breastfeeding women in resource-limited areas has proven remarkably successful at reducing HIV vertical transmission rates over the past several decades. Yet, still, more than 170,000 children are infected annually due to failures in therapy implementation, monitoring, and adherence. Mother-to-child transmission (MTCT) of HIV-1 can occur at one of several distinct stages of infant development – intrauterine, intrapartum, and postpartum. The heterogeneity of the maternal-fetal interface at each of these modes of transmission poses a challenge for the implementation of immune interventions to prevent all modes of HIV MTCT. However, using mother-infant human cohorts and nonhuman primate models of infant simian immunodeficiency virus (SIV) acquisition, investigators have made an important observation about the biology of pediatric HIV infection and have identified unique protective immune factors for each mode of transmission. Knowledge of immune factors protective against HIV MTCT will be critical to the development of targeted immune therapies to prevent infant HIV acquisition and to bring an end to the pediatric AIDS epidemic.

Aids in Infants and Children

Children are infected by HIV, 80% vertically, from HIV infected mothetS mostly near or at delivery. Because heterosexual transmission of HIV among adults is more and more important it is estimated that at the end of this century there will be totally more than 10 million HIV infected children. Three quarters of HIV-infected babies show non specific symptoms at the early phase, including failure to thrive, chronic diarrhea, recurrent bacterial injections, mucocutanous infection. Cytotropism of HIV to neroe cells resul.ts tn inflammation, neroe cell damage and neuronal loss. Progressive neurologic abnormalities and developmental milestone regression or developmental retardation will be the results. Pneumocystics carinii infection has worse prognosis than lymphocytic interstitial pneumonia which more commonly occurred in HIV injected children. Diarrhea is a troublesome problem in children with AIDS. Kaposi's sarcoma and secondary cancer are rare in pediatric AIDS. Anemia and thrombocytopenia is common among AIDS children. In developing countries children with AIDS die within the year following the appearance of the symptoms, whereas asymptomatic HIV-injected children will live longer with high risk of recurrent and opportunistic injections. The hallmark of AIDS in children is the same as in adults,iI.e. the decrease of the number and function of CD4 lymphocytes. This in turn influences the junctions of other immunocompetent cells and loss of immunity is the result. Many things are still unexplainable in children AIDS.