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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.5-9 Further support for the notion that most HIV transmission occurs intrapartum includes the association of transmission with prolonged duration of membrane rupture,10-12 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.

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