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Contempo Updates
February 14, 2001

Understanding the Timing of HIV Transmission From Mother to Infant

Author Affiliations

Author Affiliations: Division of Infectious Diseases, Epidemiology and Immunology, Department of Pediatrics, Emory University School of Medicine (Drs Kourtis, Nesheim, and Lee), and Division of HIV/AIDS Prevention, Surveillance and Epidemiology, Centers for Disease Control and Prevention (Dr Bulterys), Atlanta, Ga.


Contempo Updates Section Editors: Stephen J. Lurie, MD, PhD, Senior Editor; Alice T. D. Hughes, MD, Fishbein Fellow.

JAMA. 2001;285(6):709-712. doi:10.1001/jama.285.6.709

Mother-to-infant transmission of human immunodeficiency virus (HIV) occurs, without any intervention, at rates of 14% to 42% in various settings.1,2 Determining the timing of such transmission is of great clinical relevance for implementing cost-effective prophylaxis.3,4 Based on virologic detection of HIV during the infant's first 2 days of life, it is generally accepted that about one third of transmissions in nonbreastfeeding women occur during gestation and the remaining two thirds during delivery.59 Further support for the notion that most HIV transmission occurs intrapartum includes the association of transmission with prolonged duration of membrane rupture,1012 the protective effect of elective cesarean delivery,1316 and a virologic and immunologic pattern of acute primary HIV infection in a majority of affected infants.17 However, these findings could be explained by transmission either very late in gestation or during labor.

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