HIV In Infants and Children

    The risk of MTCT is significantly increased if the mother has
    advanced HIV disease, increased levels of HIV in her bloodstream, or
    fewer numbers of the immune system cells-CD4+ T cells-that are the main
    targets of HIV.

    Other factors that may increase the risk are maternal drug use,
    severe inflammation of fetal membranes, or a prolonged period between
    membrane rupture and delivery. A study sponsored by NIAID and others
    found that HIV-infected women who gave birth more than 4 hours after the
    rupture of the fetal membranes were nearly twice as likely to transmit
    HIV to their infants, as compared to women who delivered within 4 hours
    of membrane rupture.

    BREASTFEEDING

    HIV also may be transmitted from a
    nursing mother to her infant. Studies have suggested that breastfeeding
    introduces an additional risk of HIV transmission of approximately 10 to
    14 percent among women with chronic HIV infection. In developing
    countries, an estimated one-third to one-half of all HIV infections are
    transmitted through breastfeeding.

    WHO recommends that all HIV-infected women be advised about both the
    risks and benefits of breastfeeding for their infants so they can make
    informed decisions. In countries where safe alternatives to
    breastfeeding are readily available and economically feasible, this
    alternative should be encouraged. In general, in developing countries
    where safe alternatives to breastfeeding are not readily available, the
    benefits of breastfeeding in terms of decreased illness and death due to
    other infectious diseases greatly outweigh the potential risk of HIV
    transmission.

    PREVENTING MOTHER-TO-CHILD TRANSMISSION

    In 1994, a landmark
    study conducted by the PACTG demonstrated that AZT, given to
    HIV-infected women who had very little or no prior antiretroviral
    therapy and CD4+ T-cell counts above 200/mm3, reduced the
    risk of MTCT by two-thirds, from 25 percent to 8 percent. In the study,
    AZT therapy was initiated in the second or third trimester and continued
    during labor, and infants were treated for 6 weeks following birth. AZT
    produced no serious side effects in mothers or infants. Long-term
    follow up of the infants and mothers is ongoing.

    A few years later, another PACTG study found that the risk of
    transmitting HIV from an HIV-positive mother to her newborn infant could
    be reduced to 1.5 percent in those women who received antiretroviral
    treatment and appropriate medical and obstetrical care during pregnancy.

    Combination therapies have been shown to be beneficial in treating HIV-infected adults, and current guidelines have

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