Second International Congress Drug Therapy in HIV Infection 18-22 November 1994 Glasgow, UK

THE PREVENTION OF VERTICAL TRANSMISSION

Diane W. Wara, M.D.
University of California, San Francisco, 505 Parnassus Avenue, San Francisco, California U.S.A.

Int Cong Drug Therapy HIV 1994 Nov 18-22;2:Abstract No. 14.2
AIDS 1994, Vol. 8 (Suppl. 4);S12

The most important advance in clinical Pediatric HIV-1 infection during the past year is the demonstration that perinatal transmission can be reduced from 25% to 8% by the administration of oral Zidovudine to HIV-1 infected women during pregnancy, intravenously during labor, and oral suspension to newborns from birth to age 6 weeks. Although this approach to decreasing perinatal transmission is expensive and is not practical for use throughout the world, the results demonstrate that transmission can be altered, probably by decreasing maternal viral burden.

Risk factors for transmission include maternal viral burden, viral phenotype, immune status, disease stage, co-infection with STD's, and obstetrical events. Infant risk factors that increase transmission include prematurity, blood exposure during delivery and skin breaks. Timing of Transmission is a major determinant of approaches to prevention. Preliminary data suggests that 50-80% of transmission occurs during the intrapartum and postnatal periods.

Approaches to decreasing vertical transmission include:

1) Decreasing maternal viral burden by the use of antiretroviral therapy as in ACTG 076. Non-nucleoside reverse transcriptase inhibitors, such as Nevirapine, which act promptly to decrease viral burden, may be promising.

2) Decreasing infant exposure to virus during labor and delivery may be approached by vaginal wash with vermicidal agents during labor, restricting he use of scalp electrodes, bathing the infant immediately after delivery.

3) Enhancing the infant's immune response by the use of active immunization (vaccines) plus passive immunization (HIVIG and/or monoclonal antibody) may prevent infection or alter the clinical course following infection. Clinical trials are planned or ongoing to address each of the above approaches through the Pediatric ACTG, the European Collaborative Group, or the World Health Organization.

Presenting author: Diane W. Wara, M.D.

1994-11-18
14.2

Originally published in AIDS Volume 8, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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