Perinatal Human Immunodeficiency Virus Infection

Infection with human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS) has become a significant medical problem during the 1980s. Hundreds of infants and thousands of women have been reported to have AIDS. In addition, there are thousands more women infected with HIV, at risk for AIDS, and capable of transmitting HIV to their fetuses/infants if they become pregnant. DEFINITIONS Perinatal, the time period including pregnancy through 28 postnatal days; congenital (intrauterine) infection, infection acquired transplacentally; intrapartum infection, infection acquired during the time of delivery; postnatal infection, infection acquired after pregnancy and delivery; HIV infection, asymptomatic or symptomatic infection with HIV; AIDS, meeting the Centers for Disease Control definition for AIDS. EPIDEMIOLOGIC FEATURES OF AIDS AND HIV The primary risk factor for AIDS in infants is congenital (and possibly intrapartum) exposure to a mother infected with HIV. Other risks have included transfusion of blood or clotting factor concentrates. However, since the institution of routine testing of blood donors, these risks have become extremely small. Because the majority of women with AIDS (78%) are of childbearing age, it is important that the physician inquire about risk factors in women of childbearing age to provide optimal care and prevention of HIV transmission. The primary risk factors for AIDS in the reported cases in women are IV drug abuse (49%), hetero-sexual transmission from a person known to be at risk of HIV infection (28%), and transfusion or clotting factor therapy before blood was screened in middle 1985 (11%).1,2 Although the sex distribution of pediatric AIDS cases is relatively even (54% boys, 46% girls), the racial distribution of pediatric AIDS is uneven: blacks 54%, Hispanics 24%, whites 21%, and others 1%.3