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.
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.5- 9
Further support for the notion that most HIV transmission occurs intrapartum
includes the association of transmission with prolonged duration of membrane
the protective effect of elective cesarean delivery,13- 16
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.
Kourtis AP, Bulterys M, Nesheim SR, Lee FK. Understanding the Timing of HIV Transmission From Mother to Infant. JAMA. 2001;285(6):709-712. doi:10.1001/jama.285.6.709