title: The role of cell-associated virus in mother-to-child HIV transmission.
abstract: Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) continues to contribute to the global burden of disease despite great advances in antiretroviral (ARV) treatment and prophylaxis. In this review, we discuss the proposed mechanisms of MTCT, evidence for cell-free and cell-associated transmission in different routes of MTCT, and the impact of ARVs on virus levels and transmission. Many population-based studies support a role for cell-associated virus in transmission and in vitro studies also provide some support for this mode of transmission. However, animal model studies provide proof-of-principle that cell-free virus can establish infection in infants, and studies of ARVs in HIV-infected pregnant women show a strong correlation with reduction in cell-free virus levels and protection. ARV treatment in MTCT potentially provides opportunities to better define the infectious form of virus, but these studies will require better tools to measure the infectious cell reservoir.
authors.affiliation: Division of Human Biology, Fred Hutchinson Cancer Research Center Medical Scientist Training Program, University of Washington School of Medicine Graduate Program in Pathobiology, Department of Global Health, University of Washington, Seattle, Washington.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Milligan
authors.affiliation: Division of Human Biology, Fred Hutchinson Cancer Research Center Medical Scientist Training Program, University of Washington School of Medicine.
authors.forename: Julie
authors.initials: J
authors.lastname: Overbaugh
mesh_terms: D000818:Animals; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001942:Breast Feeding / Q000009:adverse effects; D005260:Female; D006678:HIV / Q000187:drug effects / Q000502:physiology*; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission* / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008895:Milk, Human / Q000821:virology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology
chemical_list: D019380:Anti-HIV Agents
keywords: HIV-1; breast milk; cell-associated virus; cell-free virus; genital secretions; infected leukocytes; mother-to-child transmission