A prospective population-based study of HIV perinatal transmission.
OBJECTIVE
To estimate the perinatal HIV transmission rate and describe the natural history of infant HIV infection in a situation in which HIV status is known in more than 95% of delivering women.


METHODS
A cohort of HIV-exposed infants born between 7 July 1987 and 30 June 1990, whose mothers were identified by routine voluntary universal HIV testing, were followed using clinical and laboratory measures.


METHODS
Grady Memorial Hospital, a major health-care site for individuals of lower socioeconomic status in Atlanta, Georgia, USA, with approximately 7000 deliveries per year.


METHODS
HIV-exposed infants (n = 165), 98% of whom were African American.


RESULTS
Annual maternal HIV seroprevalence increased from 0.58 to 0.86%. The annual proportion of HIV-positive women having a second delivery increased from 4.3 to 25%. Clinical outcome was known for 132 out of 165 infants (22 infected and 110 uninfected), the transmission rate was 17% (confidence interval, 11-24%). The rate declined to 11% by the third year of the study. Gestational growth, prematurity and mode of delivery were unrelated to infant outcome. There was a trend for intravenous drug use to be more common in mothers of infected infants (P = 0.08). After 35 months median follow-up of infected infants, eight out of 22 (36%) had an opportunistic infection (seven Pneumocystis carinii pneumonia); three out of 22 (14%) had lymphocytic interstitial pneumonia, and 10 out of 22 (45%) were asymptomatic or had only nonspecific symptoms. Cumulative mortality in infected infants was 9, 32 and 32% by 1, 2 and 3 years of age, respectively.


CONCLUSIONS
In this cohort of HIV-exposed infants, perinatal HIV transmission was 17% overall. Factors affecting the transmission rate and possible future changes in the rate require further study.
Nesheim
S R
SR
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30303.
Lindsay
M
M
Sawyer
M K
MK
Mancao
M
M
Lee
F K
FK
Shaffer
N
N
Jones
D
D
Slade
B A
BA
Ou
C Y
CY
Nahmias
A
A
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005845:Georgia / Q000453:epidemiology; D015658:HIV Infections / Q000401:mortality / Q000635:transmission*; D015528:HIV Seroprevalence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors